Mehrdad Azimi1, Lisa Burry2, Christinne Duclos3, Jordan Pelc4, Jason X Nie5, Ross Upshur6. 1. , MSc, is a candidate in the PharmD program, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario. He is also with the Department of Pharmacy, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario. 2. , BScPharm, PharmD, FCCP, FCCM, is with the Leslie Dan Faculty of Pharmacy, University of Toronto, and the Department of Pharmacy and the Department of Medicine, Division of Intensive Care Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario. 3. , BScPharm, PharmD, is with the Department of Pharmacy, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario. 4. , MD, MSc, CCFP, is with the Department of Medicine, Bridgepoint Active Healthcare, the Division of General Internal Medicine, and the Interdepartmental Division of Hospital Medicine, Sinai Health System; and the Department of Family and Community Medicine, University of Toronto, Toronto, Ontario. 5. , MSc, is with the Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario. 6. , BA(Hons), MA, MD, MSc, CCFP, FRCPC, is with the Department of Medicine, Bridgepoint Active Healthcare, and the Lunenfeld-Tanenbaum Research Institute, Sinai Health System; and the Department of Family and Community Medicine and the Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.
Abstract
BACKGROUND: The population of patients designated as alternate level of care (ALC) consists predominantly of frail older adults who are medically stable and awaiting discharge from hospital. They have complex medication regimens, often including potentially inappropriate medications (PIMs). There has been increasing emphasis on managing the burden that ALC patients place on the health care system, but little is known about their health care needs. OBJECTIVE: To characterize the medication regimens, including use of PIMs, of ALC patients at the study institution. METHODS: A cross-sectional chart audit of ALC patients was conducted between May and July 2017. For all patients in the sample, each medication was categorized by therapeutic class, and PIMs were categorized according to the Beers criteria, the STOPP/START criteria, and an established list of high-alert medications. RESULTS: A total of 82 patients met the audit criteria, for whom the mean number of chronic conditions was 6.4 (standard deviation [SD] 3.3) and the mean number of prescribed medications was 12.8 (SD 6.9). Twenty-four (29%) of the patients were receiving at least 1 drug from 7 different drug classes. All but one of the patients had PIMs in their regimen; the frequency of PIMs was highest according to the Beers criteria (mean 3.9 [SD 2.6] medications per patient). CONCLUSIONS: At the study institution, ALC patients had on average more than 6 chronic conditions managed with at least 12 medications, of which one-quarter were PIMs. These data will be used to inform next steps in making recommendations to simplify, reduce, or discontinue medications for which there is an unclear indication, lack of effectiveness, or evidence of potential harm.
BACKGROUND: The population of patients designated as alternate level of care (ALC) consists predominantly of frail older adults who are medically stable and awaiting discharge from hospital. They have complex medication regimens, often including potentially inappropriate medications (PIMs). There has been increasing emphasis on managing the burden that ALC patients place on the health care system, but little is known about their health care needs. OBJECTIVE: To characterize the medication regimens, including use of PIMs, of ALC patients at the study institution. METHODS: A cross-sectional chart audit of ALC patients was conducted between May and July 2017. For all patients in the sample, each medication was categorized by therapeutic class, and PIMs were categorized according to the Beers criteria, the STOPP/START criteria, and an established list of high-alert medications. RESULTS: A total of 82 patients met the audit criteria, for whom the mean number of chronic conditions was 6.4 (standard deviation [SD] 3.3) and the mean number of prescribed medications was 12.8 (SD 6.9). Twenty-four (29%) of the patients were receiving at least 1 drug from 7 different drug classes. All but one of the patients had PIMs in their regimen; the frequency of PIMs was highest according to the Beers criteria (mean 3.9 [SD 2.6] medications per patient). CONCLUSIONS: At the study institution, ALC patients had on average more than 6 chronic conditions managed with at least 12 medications, of which one-quarter were PIMs. These data will be used to inform next steps in making recommendations to simplify, reduce, or discontinue medications for which there is an unclear indication, lack of effectiveness, or evidence of potential harm.
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