Abby Emdin1,2, Marina Strzelecki3, Winnie Seto1,3,4,5, James Feinstein6, Orly Bogler7, Eyal Cohen1,8,4, Daniel E Roth1,8,2,4. 1. Child Health Evaluative Sciences and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada. 2. Dalla Lana School of Public Health. 3. Department of Pharmacy, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. 4. Institute of Health Policy, Management and Evaluation. 5. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada. 6. Adult and Child Consortium for Health Outcomes Research and Delivery Science, Children's Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado. 7. Faculty of Medicine. 8. Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
Abstract
BACKGROUND AND OBJECTIVES: Discharge prescription practices may contribute to medication overuse and polypharmacy. We aimed to estimate changes in the number and types of medications reported at inpatient discharge (versus admission) at a tertiary care pediatric hospital. METHODS: Electronic medication reconciliation data were extracted for inpatient admissions at The Hospital for Sick Children from January 1, 2016, to December 31, 2017 (n = 22 058). Relative changes in the number of medications and relative risks (RRs) of specific types and subclasses of medications at discharge (versus admission) were estimated overall and stratified by the following: sex, age group, diagnosis of a complex chronic condition, surgery, or ICU (PICU) admission. Micronutrient supplements, nonopioid analgesics, cathartics, laxatives, and antibiotics were excluded in primary analyses. RESULTS: Medication counts at discharge were 1.27-fold (95% confidence interval [CI]: 1.25-1.29) greater than admission. The change in medications at discharge (versus admission) was increased by younger age, absence of a complex chronic condition, surgery, PICU admission, and discharge from a surgical service. The most common drug subclasses at discharge were opioids (22% of discharges), proton pump inhibitors (18%), bronchodilators (10%), antiemetics (9%), and corticosteroids (9%). Postsurgical patients had higher RRs of opioid prescriptions at discharge (versus admission; RR: 13.3 [95% CI: 11.5-15.3]) compared with nonsurgical patients (RR: 2.38 [95% CI: 2.22-2.56]). CONCLUSIONS: Pediatric inpatients were discharged from the hospital with more medications than admission, frequently with drugs that may be discretionary rather than essential. The high frequency of opioid prescriptions in postsurgical patients is a priority target for educational and clinical decision support interventions.
BACKGROUND AND OBJECTIVES: Discharge prescription practices may contribute to medication overuse and polypharmacy. We aimed to estimate changes in the number and types of medications reported at inpatient discharge (versus admission) at a tertiary care pediatric hospital. METHODS: Electronic medication reconciliation data were extracted for inpatient admissions at The Hospital for Sick Children from January 1, 2016, to December 31, 2017 (n = 22 058). Relative changes in the number of medications and relative risks (RRs) of specific types and subclasses of medications at discharge (versus admission) were estimated overall and stratified by the following: sex, age group, diagnosis of a complex chronic condition, surgery, or ICU (PICU) admission. Micronutrient supplements, nonopioid analgesics, cathartics, laxatives, and antibiotics were excluded in primary analyses. RESULTS: Medication counts at discharge were 1.27-fold (95% confidence interval [CI]: 1.25-1.29) greater than admission. The change in medications at discharge (versus admission) was increased by younger age, absence of a complex chronic condition, surgery, PICU admission, and discharge from a surgical service. The most common drug subclasses at discharge were opioids (22% of discharges), proton pump inhibitors (18%), bronchodilators (10%), antiemetics (9%), and corticosteroids (9%). Postsurgical patients had higher RRs of opioid prescriptions at discharge (versus admission; RR: 13.3 [95% CI: 11.5-15.3]) compared with nonsurgical patients (RR: 2.38 [95% CI: 2.22-2.56]). CONCLUSIONS: Pediatric inpatients were discharged from the hospital with more medications than admission, frequently with drugs that may be discretionary rather than essential. The high frequency of opioid prescriptions in postsurgical patients is a priority target for educational and clinical decision support interventions.
Authors: Courtney Baker; James A Feinstein; Xuan Ma; Shari Bolen; Neal V Dawson; Negar Golchin; Alexis Horace; Lawrence C Kleinman; Sharon B Meropol; Elia M Pestana Knight; Almut G Winterstein; Paul M Bakaki Journal: Pharmacoepidemiol Drug Saf Date: 2019-02-06 Impact factor: 2.890
Authors: Lorraine I Kelley-Quon; Matthew G Kirkpatrick; Robert L Ricca; Robert Baird; Calista M Harbaugh; Ashley Brady; Paula Garrett; Hale Wills; Jonathan Argo; Karen A Diefenbach; Marion C W Henry; Juan E Sola; Elaa M Mahdi; Adam B Goldin; Shawn D St Peter; Cynthia D Downard; Kenneth S Azarow; Tracy Shields; Eugene Kim Journal: JAMA Surg Date: 2021-01-01 Impact factor: 14.766