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Fisher SR, Villasante-Tezanos A, Allen LM, Pappadis MR, Kilic G. Comparative effectiveness of pelvic floor muscle training, mirabegron, and trospium among older women with urgency urinary incontinence and high fall risk: a feasibility randomized clinical study. Pilot Feasibility Stud 2024; 10:1. [PMID: 38178267 PMCID: PMC10765875 DOI: 10.1186/s40814-023-01440-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Untreated, urgency urinary incontinence (UUI) and overactive bladder (OAB) can precipitate a vicious cycle of decreasing physical activity, social isolation, fear of falling, and falls. Structured behavioral interventions and medications are common initial treatment options, but they elicit their effects through very different mechanisms of action that may influence fall-related outcomes differently. This study will determine the feasibility of conducting a comparative effectiveness, three-arm, mixed methods, randomized clinical trial of a behaviorally based pelvic floor muscle training (PFMT) intervention versus two recent drug options in older women with UUI or OAB who are also at increased risk of falling. METHODS Forty-eight women 60 years and older with UUI or OAB who screen positive for increased fall risk will be recruited through the urogynacology and pelvic health clinics of our university health system. Participants will be randomly assigned to one of three 12-week treatment arms: (1) a course of behavioral and pelvic floor muscle training (PFMT) provided by physical therapists; (2) the beta-3 agonist, mirabegron; and (3) the antimuscarinic, trospium chloride. Study feasibility will be established through objective metrics of evaluability, adherence to the interventions, and attrition. We will also assess relevant measures of OAB symptom severity, quality of life, physical activity, incident falls, and concern about falling. DISCUSSION The proposed research seeks to ultimately determine if linkages between reduction in UI symptoms through treatment also reduce the risk of falling in this patient population. TRIAL REGISTRATION NCT05880862. Registered on 30 May 2023.
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Affiliation(s)
- Steve R Fisher
- Department of Physical Therapy, University of Texas Medical Branch at Galveston, Galveston, USA.
| | | | - Lindsay M Allen
- Department of Physical Therapy, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Monique R Pappadis
- Department of Population Health and Health Disparities, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Gokhan Kilic
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, USA
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Lin YY, Weng SF, Hsu CH, Huang CL, Lin YP, Yeh MC, Han AY, Hsieh YS. Effect of metformin monotherapy and dual or triple concomitant therapy with metformin on glycemic control and lipid profile management of patients with type 2 diabetes mellitus. Front Med (Lausanne) 2022; 9:995944. [PMID: 36314019 PMCID: PMC9614085 DOI: 10.3389/fmed.2022.995944] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background In this study, we aimed to compare the effects of metformin-based dual therapy versus triple therapy on glycemic control and lipid profile changes in Taiwanese patients with type 2 diabetes mellitus (T2DM). Methods In total, 60 patients were eligible for participation in this study. Patients received at least 24 months of metformin monotherapy, dual therapy, or triple therapy with metformin plus linagliptin (a dipeptidyl peptidase 4 (DPP-4) inhibitor) or dapagliflozin (a sodium-glucose cotransporter-2 (SGLT2) inhibitor). Blood samples were collected from each patient, followed by evaluation of changes in their blood glucose control and lipid profile-related markers. Results A combination of metformin and DPP4 and SGLT2 inhibitor therapy more effectively reduced low-density lipoprotein cholesterol (LDL-C) (p = 0.016) than metformin monotherapy. A combination of metformin and DPP4 and SGLT2 inhibitor therapy more effectively improved total cholesterol (Chol, p = 0.049) and high-density lipoprotein cholesterol (HDL-C) than metformin monotherapy (p = 0.037). Metformin plus linagliptin dual therapy was more effective than metformin monotherapy in reducing glycosylated hemoglobin (HbA1C, p = 0.011). Patients who received a combination of linagliptin and empagliflozin showed a significant reduction in their fasting blood glucose (p = 0.019), HbA1c (p = 0.036), and Chol (p = 0.010) compared with those who received linagliptin dual therapy. Furthermore, patients who received metformin plus dapagliflozin and saxagliptin showed significantly reduced Chol (p = 0.011) and LDL-C (p = 0.035) levels compared with those who received metformin plus dapagliflozin. Conclusion In conclusion, dual therapy with metformin and linagliptin yields similar glycemic control ability to triple therapy. Among metformin combination triple therapy, triple therapy of empagliflozin and linagliptin might have a better glycemic control ability than dual therapy of linagliptin. Moreover, Triple therapy of dapagliflozin and saxagliptin might have a better lipid control ability than dual therapy of dapagliflozin.
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Affiliation(s)
- Yan-Yu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Shuen-Fu Weng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan,Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Chung-Huei Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Chen-Ling Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Yu-Pei Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Min-Chun Yeh
- Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - A-Young Han
- Department of Nursing, College of Life Science and Industry, Sunchon National University, Suncheon, South Korea
| | - Yu-Shan Hsieh
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan,*Correspondence: Yu-Shan Hsieh,
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Wang S, Zhu X. Predictive Modeling of Hospital Readmission: Challenges and Solutions. IEEE/ACM TRANSACTIONS ON COMPUTATIONAL BIOLOGY AND BIOINFORMATICS 2022; 19:2975-2995. [PMID: 34133285 DOI: 10.1109/tcbb.2021.3089682] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Hospital readmission prediction is a study to learn models from historical medical data to predict probability of a patient returning to hospital in a certain period, e.g. 30 or 90 days, after the discharge. The motivation is to help health providers deliver better treatment and post-discharge strategies, lower the hospital readmission rate, and eventually reduce the medical costs. Due to inherent complexity of diseases and healthcare ecosystems, modeling hospital readmission is facing many challenges. By now, a variety of methods have been developed, but existing literature fails to deliver a complete picture to answer some fundamental questions, such as what are the main challenges and solutions in modeling hospital readmission; what are typical features/models used for readmission prediction; how to achieve meaningful and transparent predictions for decision making; and what are possible conflicts when deploying predictive approaches for real-world usages. In this paper, we systematically review computational models for hospital readmission prediction, and propose a taxonomy of challenges featuring four main categories: (1) data variety and complexity; (2) data imbalance, locality and privacy; (3) model interpretability; and (4) model implementation. The review summarizes methods in each category, and highlights technical solutions proposed to address the challenges. In addition, a review of datasets and resources available for hospital readmission modeling also provides firsthand materials to support researchers and practitioners to design new approaches for effective and efficient hospital readmission prediction.
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Bajeux E, Alix L, Cornée L, Barbazan C, Mercerolle M, Howlett J, Cruveilhier V, Liné-Iehl C, Cador B, Jego P, Gicquel V, Schweyer FX, Marie V, Hamonic S, Josselin JM, Somme D, Hue B. Pharmacist-led medication reconciliation at patient discharge: a tool to reduce healthcare utilization? an observational study in patients 65 years or older. BMC Geriatr 2022; 22:576. [PMID: 35831783 PMCID: PMC9281036 DOI: 10.1186/s12877-022-03192-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background Older patients often experience adverse drug events (ADEs) after discharge that may lead to unplanned readmission. Medication Reconciliation (MR) reduces medication errors that lead to ADEs, but results on healthcare utilization are still controversial. This study aimed to assess the effect of MR at discharge (MRd) provided to patients aged over 65 on their unplanned rehospitalization within 30 days and on both patients’ experience of discharge and their knowledge of their medication. Methods An observational multicenter prospective study was conducted in 5 hospitals in Brittany, France. Results Patients who received both MR on admission (MRa) and MRd did not have significantly fewer deaths, unplanned rehospitalizations and/or emergency visits related to ADEs (OR = 1.6 [0.7 to 3.6]) or whatever the cause (p = 0.960) 30 days after discharge than patients receiving MRa alone. However, patients receiving both MRa and MRd were more likely to feel that their discharge from the hospital was well organized (p = 0.003) and reported more frequently that their community pharmacist received information about their hospital stay (p = 0.036). Conclusions This study found no effect of MRd on healthcare utilization 30 days after discharge in patients over 65, but the process improved patients’ experiences of care continuity. Further studies are needed to better understand this positive impact on their drug care pathway in order to improve patients’ ownership of their drugs, which is still insufficient. Improving both the interview step between pharmacist and patient before discharge and the transmission of information from the hospital to primary care professionals is needed to enhance MR effectiveness. Trial registration NCT04018781 July 15, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03192-3.
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Affiliation(s)
- Emma Bajeux
- Department of Epidemiology and Public Health, Univ Rennes, Rennes University Hospital, F-35000, Rennes, France.
| | - Lilian Alix
- Department of Internal Medicine and Clinical Immunology, Univ Rennes, Rennes University Hospital, F-35000, Rennes, France
| | - Lucie Cornée
- Department of Geriatrics, St-Laurent Polyclinic, Hospitalité St-Thomas de Villeneuve, F-35000, Rennes, France
| | - Camille Barbazan
- Department of Pharmacy, Rennes University Hospital, F-35000, Rennes, France
| | - Marion Mercerolle
- Department of Pharmacy, Rennes University Hospital, F-35000, Rennes, France
| | - Jennifer Howlett
- Department of Pharmacy, Rennes University Hospital, F-35000, Rennes, France
| | | | - Charlotte Liné-Iehl
- Department of Pharmacy, Montfort/Meu Hospital, F-35160, Montfort/Meu, France
| | - Bérangère Cador
- Department of Internal Medicine and Clinical Immunology, Univ Rennes, Rennes University Hospital, F-35000, Rennes, France
| | - Patrick Jego
- Department of Internal Medicine and Clinical Immunology, Univ Rennes, Rennes University Hospital, F-35000, Rennes, France
| | - Vincent Gicquel
- Department of Pharmacy, Rennes University Hospital, F-35000, Rennes, France
| | - François-Xavier Schweyer
- Department of Human and Social Sciences, Univ Rennes, EHESP, EA7348 MOS, F-35000, Rennes, France
| | | | - Stéphanie Hamonic
- Department of Epidemiology and Public Health, Univ Rennes, Rennes University Hospital, F-35000, Rennes, France
| | | | - Dominique Somme
- Department of Geriatrics, Department of Geriatrics, Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U 1309 , F-35000, Rennes, France
| | - Benoit Hue
- Department of Pharmacy, Rennes University Hospital, F-35000, Rennes, France
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Schmid O, Bereznicki B, Peterson GM, Stankovich J, Bereznicki L. Persistence of Adverse Drug Reaction-Related Hospitalization Risk Following Discharge. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095585. [PMID: 35564982 PMCID: PMC9101512 DOI: 10.3390/ijerph19095585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 12/28/2022]
Abstract
This retrospective cohort study analyzed the administrative hospital records of 91,500 patients with the aim of assessing adverse drug reaction (ADR)-related hospital admission risk after discharge from ADR and non-ADR-related admission. Patients aged ≥18 years with an acute admission to public hospitals in Tasmania, Australia between 2011 and 2015 were followed until May 2017. The index admissions (n = 91,550) were stratified based on whether they were ADR-related (n = 2843, 3.1%) or non-ADR-related (n = 88,707, 96.9%). Survival analysis assessed the post-index ADR-related admission risk using (1) the full dataset, and (2) a matched subset of patients using a propensity score analysis. Logistic regression was used to identify the risk factors for ADR-related admissions within 90 days of post-index discharge. The patients with an ADR-related index admission were almost five times more likely to experience another ADR-related admission within 90 days (p < 0.001). An increased risk persisted for at least 5 years (p < 0.001), which was substantially longer than previously reported. From the matched subset of patients, the risk of ADR-related admission within 90 and 365 days more than doubled in the patients with an ADR-related index admission (p < 0.0001). These admissions were often attributed to the same drug class as the patients’ index ADR-related admission. Cancer was a major risk factor for ADR-related re-hospitalization within 90 days; other factors included heart failure and increasing age.
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Affiliation(s)
- Olive Schmid
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7001, Australia; (G.M.P.); (J.S.); (L.B.)
- Correspondence:
| | - Bonnie Bereznicki
- Tasmanian School of Medicine, University of Tasmania, Hobart, TAS 7000, Australia;
| | - Gregory Mark Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7001, Australia; (G.M.P.); (J.S.); (L.B.)
| | - Jim Stankovich
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7001, Australia; (G.M.P.); (J.S.); (L.B.)
| | - Luke Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7001, Australia; (G.M.P.); (J.S.); (L.B.)
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Higi L, Lisibach A, Beeler PE, Lutters M, Blanc AL, Burden AM, Stämpfli D. External validation of the PAR-Risk Score to assess potentially avoidable hospital readmission risk in internal medicine patients. PLoS One 2021; 16:e0259864. [PMID: 34813625 PMCID: PMC8610256 DOI: 10.1371/journal.pone.0259864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Readmission prediction models have been developed and validated for targeted in-hospital preventive interventions. We aimed to externally validate the Potentially Avoidable Readmission-Risk Score (PAR-Risk Score), a 12-items prediction model for internal medicine patients with a convenient scoring system, for our local patient cohort. METHODS A cohort study using electronic health record data from the internal medicine ward of a Swiss tertiary teaching hospital was conducted. The individual PAR-Risk Score values were calculated for each patient. Univariable logistic regression was used to predict potentially avoidable readmissions (PARs), as identified by the SQLape algorithm. For additional analyses, patients were stratified into low, medium, and high risk according to tertiles based on the PAR-Risk Score. Statistical associations between predictor variables and PAR as outcome were assessed using both univariable and multivariable logistic regression. RESULTS The final dataset consisted of 5,985 patients. Of these, 340 patients (5.7%) experienced a PAR. The overall PAR-Risk Score showed rather poor discriminatory power (C statistic 0.605, 95%-CI 0.575-0.635). When using stratified groups (low, medium, high), patients in the high-risk group were at statistically significant higher odds (OR 2.63, 95%-CI 1.33-5.18) of being readmitted within 30 days compared to low risk patients. Multivariable logistic regression identified previous admission within six months, anaemia, heart failure, and opioids to be significantly associated with PAR in this patient cohort. CONCLUSION This external validation showed a limited overall performance of the PAR-Risk Score, although higher scores were associated with an increased risk for PAR and patients in the high-risk group were at significantly higher odds of being readmitted within 30 days. This study highlights the importance of externally validating prediction models.
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Affiliation(s)
- Lukas Higi
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
- PEDeus Ltd., Zurich, Switzerland
| | - Angela Lisibach
- Department Medical Services, Clinical Pharmacy, Cantonal Hospital of Baden, Baden, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland
| | - Patrick E. Beeler
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Monika Lutters
- Department Medical Services, Clinical Pharmacy, Cantonal Hospital of Baden, Baden, Switzerland
| | - Anne-Laure Blanc
- Clinical Pharmacy, Pharmacy of Eastern Vaud Hospitals, Rennaz, Switzerland
| | - Andrea M. Burden
- Department of Chemistry and Applied Biosciences, Institue of Pharmaceutical Sciences, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Dominik Stämpfli
- Department Medical Services, Clinical Pharmacy, Cantonal Hospital of Baden, Baden, Switzerland
- Department of Chemistry and Applied Biosciences, Institue of Pharmaceutical Sciences, Swiss Federal Institute of Technology, Zurich, Switzerland
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Coppes T, van der Kloes J, Dalleur O, Karapinar-Çarkit F. Identifying medication-related readmissions: Two students using tools vs a multidisciplinary panel. Int J Clin Pract 2021; 75:e14768. [PMID: 34486783 DOI: 10.1111/ijcp.14768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/11/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Polypharmacy may result in medication-related readmissions (MRRs). Identifying MRRs is time consuming. Screening of readmissions by students could increase efficiency for healthcare professionals. Recently, two screening tools have been published: the Assessment Tool for identifying Hospital Admissions Related to Medications (AT-HARM10) tool and the Drug-Related Admission (DRA) adjudication guide. It is unknown whether pharmacy students could identify MRRs with these tools. OBJECTIVE To compare the agreement between two pharmacy students applying the AT-HARM10 tool and DRA adjudication guide in identifying MRRs vs a multidisciplinary panel. METHODS A retrospective study was conducted from February to July 2020 at OLVG hospital. Readmissions within 30 days after discharge from seven departments were reviewed by a multidisciplinary panel (pharmacists and physicians). MRRs were defined as readmission where medication was the main cause or medication significantly contributed to the readmission. Two 5th year pharmacy-students volunteered to blindly apply both tools individually on all MRRs and a random sample of non-MRRs. The consensus results of the students and the multidisciplinary panel were compared and displayed as a percentage and Cohen's kappa (κ). RESULTS Three hundred sixty-six readmission cases were selected in total, consisting of 181 MRRs and 185 non-MRRs. The agreement between the students using the AT-HARM10 tool vs the multidisciplinary panel was moderate (80%, κ = 0.60 (95% confidence interval (CI): 0.52-0.68)). The DRA adjudication guide had a moderate agreement (81%, κ = 0.62 (CI: 0.54-0.70)). Students misclassified MRRs mainly because the multidisciplinary panel found disease progression more profound than a contribution of medication. CONCLUSIONS Two students have an overall agreement of 80% in comparison with the multidisciplinary panel with a moderate Cohen's kappa. Students are more often overestimated, but they may be a good option to preselect potential MRRs to save time for healthcare professionals. However, some MRRs will be missed.
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Affiliation(s)
- Tristan Coppes
- Department of Clinical Pharmacy, OLVG, Amsterdam, The Netherlands
| | | | - Olivia Dalleur
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Pharmacy, Cliniques universitaires Saint-Luc, Université catholique de Louvain UCLouvain, Brussels, Belgium
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Prevalence and Predictors of Increased Fall Risk Among Women Presenting to an Outpatient Urogynecology and Pelvic Health Center. Female Pelvic Med Reconstr Surg 2021; 28:e7-e10. [PMID: 34628446 DOI: 10.1097/spv.0000000000001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study was to determine the prevalence of increased fall risk among women presenting to a large pelvic health center using a screening method compatible with the busy clinic environment and to identify factors associated with increased risk. METHODS A retrospective medical records review was conducted on consecutive treatment-seeking women presenting to a Urogynecology & Pelvic Health Center over 6 months. The Centers for Disease Control and Prevention, Stopping Elderly Accidents, Deaths, and Injuries fall risk screening tool was included among the intake questionnaires all patients completed before their scheduled appointments. Relevant sociodemographic and clinical measures were abstracted from the electronic medical record. RESULTS Three hundred and forty-eight women completed the fall screen. One hundred and twenty-four (36%) screened positive for increased fall risk. Mean age was 58.7 ± 15.8 years. An age threshold of 68 years best discriminated between those who were and were not identified as at risk. There was a gradient of association between number of urinary symptoms and prevalence of increased fall risk. Patients with 3 or more urinary symptoms were most likely to screen positive (1: odds ratio [OR], 1.51 [0.86-2.66]; 2: OR, 1.62 [0.99-2.64]; 3 or more: OR, 1.84 [1.07-3.17]) after adjusting for other know fall risk factors. CONCLUSIONS The prevalence of increased fall risk in this patient population is high and highest in women with multiple urinary symptoms. The Stopping Elderly Accidents, Deaths, and Injuries screening tool was a feasible and nonintrusive screening method for identifying increased fall risk during routine patient care. Fall risk and concern about falling should be taken into consideration when deciding management strategies for urinary problems.
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Delgado A, Stewart S, Urroz M, Rodríguez A, Borobia AM, Akatbach-Bousaid I, González-Muñoz M, Ramírez E. Characterisation of Drug-Induced Liver Injury in Patients with COVID-19 Detected by a Proactive Pharmacovigilance Program from Laboratory Signals. J Clin Med 2021; 10:4432. [PMID: 34640458 PMCID: PMC8509270 DOI: 10.3390/jcm10194432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/19/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has a wide spectrum of clinical manifestations. An elevation of liver damage markers has been observed in numerous cases, which could be related to the empirical use of potentially hepatotoxic drugs. The aim of this study was to describe the clinical and analytical characteristics and perform a causality analysis from laboratory signals available of drug-induced liver injury (DILI) detected by a proactive pharmacovigilance program in patients hospitalised for COVID-19 at La Paz University Hospital in Madrid (Spain) from 1 March 2020 to 31 December 2020. The updated Roussel Uclaf Causality Assessment Method (RUCAM) was employed to assess DILI causality. A lymphocyte transformation test (LTT) was performed on 10 patients. Ultimately, 160 patients were included. The incidence of DILI (alanine aminotransferase >5, upper limit of normal) was 4.9%; of these, 60% had previous COVID-19 hepatitis, the stay was 8.1 days longer and 98.1% were being treated with more than 5 drugs. The most frequent mechanism was hepatocellular (57.5%), with mild severity (87.5%) and subsequent recovery (88.1%). The most commonly associated drugs were hydroxychloroquine, azithromycin, tocilizumab and ceftriaxone. The highest incidence rate of DILI per 10,000 defined daily doses (DDD) was with remdesivir (992.7/10,000 DDD). Some 80% of the LTTs performed were positive, with a RUCAM score of ≥4. The presence of DILI after COVID-19 was associated with longer hospital stays. An immune mechanism has been demonstrated in a small subset of DILI cases.
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Affiliation(s)
- Ana Delgado
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
| | - Stefan Stewart
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
| | - Mikel Urroz
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
| | - Amelia Rodríguez
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
| | - Alberto M. Borobia
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
| | | | | | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
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Dreyer RP, Raparelli V, Tsang SW, D'Onofrio G, Lorenze N, Xie CF, Geda M, Pilote L, Murphy TE. Development and Validation of a Risk Prediction Model for 1-Year Readmission Among Young Adults Hospitalized for Acute Myocardial Infarction. J Am Heart Assoc 2021; 10:e021047. [PMID: 34514837 PMCID: PMC8649501 DOI: 10.1161/jaha.121.021047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Readmission over the first year following hospitalization for acute myocardial infarction (AMI) is common among younger adults (≤55 years). Our aim was to develop/validate a risk prediction model that considered a broad range of factors for readmission within 1 year. Methods and Results We used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study, which enrolled young adults aged 18 to 55 years hospitalized with AMI across 103 US hospitals (N=2979). The primary outcome was ≥1 all‐cause readmissions within 1 year of hospital discharge. Bayesian model averaging was used to select the risk model. The mean age of participants was 47.1 years, 67.4% were women, and 23.2% were Black. Within 1 year of discharge for AMI, 905 (30.4%) of participants were readmitted and were more likely to be female, Black, and nonmarried. The final risk model consisted of 10 predictors: depressive symptoms (odds ratio [OR], 1.03; 95% CI, 1.01–1.05), better physical health (OR, 0.98; 95% CI, 0.97–0.99), in‐hospital complication of heart failure (OR, 1.44; 95% CI, 0.99–2.08), chronic obstructive pulmomary disease (OR, 1.29; 95% CI, 0.96–1.74), diabetes mellitus (OR, 1.23; 95% CI, 1.00–1.52), female sex (OR, 1.31; 95% CI, 1.05–1.65), low income (OR, 1.13; 95% CI, 0.89–1.42), prior AMI (OR, 1.47; 95% CI, 1.15–1.87), in‐hospital length of stay (OR, 1.13; 95% CI, 1.04–1.23), and being employed (OR, 0.88; 95% CI, 0.69–1.12). The model had excellent calibration and modest discrimination (C statistic=0.67 in development/validation cohorts). Conclusions Women and those with a prior AMI, increased depressive symptoms, longer inpatient length of stay and diabetes may be more likely to be readmitted. Notably, several predictors of readmission were psychosocial characteristics rather than markers of AMI severity. This finding may inform the development of interventions to reduce readmissions in young patients with AMI.
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Affiliation(s)
- Rachel P Dreyer
- Center for Outcomes Research and Evaluation, Yale - New Haven Hospital New Haven CT.,Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - Valeria Raparelli
- Department of Translational Medicine University of Ferrara Ferrara Italy.,Department of Nursing University of Alberta Edmonton Canada.,University Center for Studies on Gender Medicine University of Ferrara Ferrara Italy
| | - Sui W Tsang
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Gail D'Onofrio
- Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - Nancy Lorenze
- Program on Aging Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Catherine F Xie
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Mary Geda
- Program on Aging Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Louise Pilote
- Centre for Outcomes Research and Evaluation McGill University Health Centre Research Institute Montreal Quebec Canada.,Divisions of Clinical Epidemiology and General Internal Medicine McGill University Health Centre Research Institute Montreal Quebec Canada
| | - Terrence E Murphy
- Program on Aging Department of Internal Medicine Yale School of Medicine New Haven CT
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11
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Dalleur O, Beeler PE, Schnipper JL, Donzé J. 30-Day Potentially Avoidable Readmissions Due to Adverse Drug Events. J Patient Saf 2021; 17:e379-e386. [PMID: 28306610 DOI: 10.1097/pts.0000000000000346] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the patterns of potentially avoidable readmissions due to adverse drug events (ADEs) to identify the most appropriate risk reduction interventions. METHODS In this observational study, we analyzed a random sample of 534 potentially avoidable 30-day readmissions from 10,275 consecutive discharges from the medical department of an academic hospital. Readmissions due to ADEs were reviewed to identify the causative drugs and the severity and interventions to prevent them. RESULTS Seventy cases (13.1%) of readmission were partially or predominantly due to ADEs, of which, 58 (82.9%) were serious ADEs. Overall, 65 (92.9%) of the ADEs have been confirmed to be preventable. Inappropriate prescribing was identified as the cause of ADE in 34 cases (48.6%) mainly involving diuretics, analgesics, or antithrombotics: misprescribing n = 19 (27.1%), underprescribing n = 8 (11.4%), and overprescribing n = 7 (10.0%). The remaining half of preventable ADEs (n = 36; 51.4%) were related to suboptimal patient monitoring/education, such as adherence issues (n = 6; 8.6%) or lack of monitoring (n = 31; 44.3%). In 64 cases (91.4%), the readmission could have been potentially prevented by better monitoring for drug efficacy/disease control, or for predictable side effect. Thirty-three (97.1%) of the 34 ADEs due to inappropriate prescribing could have also been prevented by better monitoring. CONCLUSIONS Adverse drug events accounted for approximately 13% of 30-day preventable readmissions. A half were due to prescription errors involving mainly diuretics, analgesics, or antithrombotics, and the other half were due to suboptimal patient monitoring/education, most frequently with antineoplastics. Both these avoidable causes may represent opportunities to reduce the total drug-related adverse events.
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12
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Paradissis C, Cottrell N, Coombes I, Scott I, Wang W, Barras M. Patient harm from cardiovascular medications. Ther Adv Drug Saf 2021; 12:20420986211027451. [PMID: 34367546 PMCID: PMC8317255 DOI: 10.1177/20420986211027451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 06/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background Medication harm can lead to hospital admission, prolonged hospital stay and poor patient outcomes. Reducing medication harm is a priority for healthcare organisations worldwide. Recent Australian studies demonstrate cardiovascular (CV) medications are a leading cause of harm. However, they appear to receive less recognition as ‘high risk’ medications compared with those classified by the medication safety acronym, ‘APINCH’ (antimicrobials, potassium, insulin, narcotics, chemotherapeutics, heparin). Our aim was to determine the scale and type of medication harm caused by CV medications in healthcare. Methods A narrative review of adult (>16 years) medication harm literature identified from PubMed and CINAHL databases was undertaken. Studies with the primary outcome of measuring the incidence of medication harm were included. Harm caused by CV medications was described and ranked against other medication classes at four key stages of a patient’s healthcare journey. Where specified, the implicated medications and type of harm were investigated. Results A total of 75 studies were identified, including seven systematic reviews and three meta-analyses, with most focussing on harm causing hospital admission. CV medications were responsible for approximately 20% of medication harm; however, this proportion increased to 50% in older populations. CV medications were consistently ranked in the top five medication categories causing harm and were often listed as the leading cause. Conclusion CV medications are a leading cause of medication harm, particularly in older adults, and should be the focus of harm mitigation strategies. A practical approach to generate awareness among health professionals is to incorporate ‘C’ (for CV medications) into the ‘APINCH’ acronym. Plain language summary
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Affiliation(s)
- Chariclia Paradissis
- School of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Neil Cottrell
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Ian Coombes
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Ian Scott
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - William Wang
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Michael Barras
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
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13
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Uitvlugt EB, Janssen MJA, Siegert CEH, Kneepkens EL, van den Bemt BJF, van den Bemt PMLA, Karapinar-Çarkit F. Medication-Related Hospital Readmissions Within 30 Days of Discharge: Prevalence, Preventability, Type of Medication Errors and Risk Factors. Front Pharmacol 2021; 12:567424. [PMID: 33927612 PMCID: PMC8077030 DOI: 10.3389/fphar.2021.567424] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 02/11/2021] [Indexed: 02/04/2023] Open
Abstract
Background: Hospital readmission rates are increasingly used as a measure of healthcare quality. Medicines are the most common therapeutic intervention but estimating the contribution of adverse drug events as a cause of readmissions is difficult. Objectives: To assess the prevalence and preventability of medication-related readmissions within 30 days after hospital discharge and to describe the risk factors, type of medication errors and types of medication involved in these preventable readmissions. Design: A cross-sectional observational study. Setting: The study took place across the cardiology, gastroenterology, internal medicine, neurology, psychiatry, pulmonology and general surgery departments in the OLVG teaching hospital, Netherlands. Participants: Patients with an unplanned readmission within 30 days after discharge from an earlier hospitalization (index hospitalization: IH) were reviewed. Measurements: The prevalence and preventability of medication-related readmissions were assessed by residents in multidisciplinary meetings. A senior internist and hospital pharmacist reassessed the prevalence and preventability of identified cases. Generalized estimating equation with logistic regression was performed to identify risk factors of potentially preventable medication-related readmissions. Results: Of 1,111 included readmissions, 181 (16%) were medication-related, of which 72 (40%) were potentially preventable. The number of medication changes at IH (Adjusted odds ratio [ORadj]: 1.14; 95% CI: 1.05–1.24) and having ≥3 hospitalizations 6 months before IH (ORadj: 2.11; 95% CI: 1.12–3.98) were risk factors of a preventable medication-related readmission. Of these preventable readmissions, 35% were due to prescribing errors, 35% by non-adherence and 30% by transition errors. Medications most frequently involved were diuretics and antidiabetics. Conclusion: This study shows that 16% of readmissions are medication-related, of which 40% are potentially preventable. If the results are confirmed in larger multicentre studies, this may indicate that more attention should be paid to medication-related harm in order to lower the overall readmission rates.
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Affiliation(s)
- Elien B Uitvlugt
- Onze Lieve Vrouwe Gasthuis OLVG, Department of Hospital Pharmacy, Amsterdam, Netherlands
| | - Marjo J A Janssen
- Onze Lieve Vrouwe Gasthuis OLVG, Department of Hospital Pharmacy, Amsterdam, Netherlands
| | - Carl E H Siegert
- Onze Lieve Vrouwe Gasthuis OLVG, Department of Internal Medicine, Amsterdam, Netherlands
| | - Eva L Kneepkens
- Onze Lieve Vrouwe Gasthuis OLVG, Department of Hospital Pharmacy, Amsterdam, Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Patricia M L A van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, Netherlands
| | - Fatma Karapinar-Çarkit
- Onze Lieve Vrouwe Gasthuis OLVG, Department of Hospital Pharmacy, Amsterdam, Netherlands
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14
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Stenholt POO, Abdullah SMOB, Sørensen RH, Nielsen FE. Independent predictors for 90-day readmission of emergency department patients admitted with sepsis: a prospective cohort study. BMC Infect Dis 2021; 21:315. [PMID: 33794801 PMCID: PMC8017866 DOI: 10.1186/s12879-021-06007-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/22/2021] [Indexed: 12/28/2022] Open
Abstract
Background The primary objective of our study was to examine predictors for readmission in a prospective cohort of sepsis patients admitted to an emergency department (ED) and identified by the new Sepsis-3 criteria. Method A single-center observational population-based cohort study among all adult (≥18 years) patients with sepsis admitted to the emergency department of Slagelse Hospital during 1.10.2017–31.03.2018. Sepsis was defined as an increase in the sequential organ failure assessment (SOFA) score of ≥2. The primary outcome was 90-day readmission. We followed patients from the date of discharge from the index admission until the end of the follow-up period or until the time of readmission to hospital, emigration or death, whichever came first. We used competing-risks regression to estimate adjusted subhazard ratios (aSHRs) with 95% confidence intervals (CI) for covariates in the regression models. Results A total of 2110 patients were admitted with infections, whereas 714 (33.8%) suffered sepsis. A total of 52 patients had died during admission and were excluded leaving 662 patients (44.1% female) with a median age of 74.8 (interquartile range: 66.0–84.2) years for further analysis. A total of 237 (35,8%; 95% CI 32.1–39.6) patients were readmitted within 90 days, and 54(8.2%) had died after discharge without being readmitted. We found that a history of malignant disease (aSHR 1,61; 1.16–2.23), if previously admitted with sepsis within 1 year before the index admission (aSHR; 1.41; 1.08–1.84), and treatment with diuretics (aSHR 1.51; 1.17–1.94) were independent predictors for readmission. aSHR (1.49, 1.13–1.96) for diuretic treatment was almost unchanged after exclusion of patients with heart failure, while aSHR (1.47, 0.96–2.25) for malignant disease was slightly attenuated after exclusion of patients with metastatic tumors. Conclusions More than one third of patients admitted with sepsis, and discharged alive, were readmitted within 90 days. A history of malignant disease, if previously admitted with sepsis, and diuretic treatment were independent predictors for 90-day readmission.
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Affiliation(s)
- Peer Oscar Overgaard Stenholt
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Ebba Lunds Vej 40A, Entrance 67, 2400 NV, Copenhagen, Denmark.
| | | | - Rune Husås Sørensen
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark.,Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Finn Erland Nielsen
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Ebba Lunds Vej 40A, Entrance 67, 2400 NV, Copenhagen, Denmark.,Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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15
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Medication-related risk factors and its association with repeated hospital admissions in frail elderly: A case control study. Res Social Adm Pharm 2020; 16:1318-1322. [DOI: 10.1016/j.sapharm.2019.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/13/2018] [Accepted: 02/01/2019] [Indexed: 11/19/2022]
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16
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Cooper JB, Jeter E, Sessoms CJ. Rates and Types of Medication-Related Problems in Patients Rehospitalized Within 30 Days of Discharge From a Community Hospital. J Pharm Technol 2020; 36:47-53. [PMID: 34752555 DOI: 10.1177/8755122519883642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Impact of medication-related problems (MRPs) on persistently high hospital readmission rates are not well described. Objective: The purpose of this study was to determine the rate and type of MRPs attributed to rehospitalization within 30 days of discharge from a general internal medicine hospitalists' service at a nonacademic medical center. Methods: A retrospective cohort study was conducted evaluating consecutive patients readmitted within 30-days after discharge to home from an internal medicine hospitalist service. Readmissions attributed to MRPs in physician documentation were systematically classified as indication, effectiveness, adverse drug reaction, or nonadherence problems and evaluated for possible preventability. Descriptive statistics were used to describe the rate and type of MRP. Results: Evaluation of consecutive 30-day readmissions (n = 203) to a nonteaching community hospital identified 50.2% of admissions attributed to MRPs. MRPs (n = 102) were categorized as problems of indication (34.3%), efficacy (19.6%), adverse drug events (18.6%), and nonadherence (27.5%). One third of 30-day readmissions in this cohort were attributed to potentially preventable MRPs. Conclusion: MRPs are frequently implicated in 30-day hospital readmissions in a nonteaching community hospital representing an opportunity for context-specific improvements.
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17
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Singotani RG, Karapinar F, Brouwers C, Wagner C, de Bruijne MC. Towards a patient journey perspective on causes of unplanned readmissions using a classification framework: results of a systematic review with narrative synthesis. BMC Med Res Methodol 2019; 19:189. [PMID: 31585528 PMCID: PMC6778387 DOI: 10.1186/s12874-019-0822-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 08/15/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Several literature reviews have been published focusing on the prevalence and/or preventability of hospital readmissions. To our knowledge, none focused on the different causes which have been used to evaluate the preventability of readmissions. Insight into the range of causes is crucial to understand the complex nature of readmissions. We conducted a systematic review to: (1) evaluate the range of causes of unplanned readmissions in a patient journey, and (2) present a cause classification framework that can support future readmission studies. METHODS A literature search was conducted in PUBMED and EMBASE using "readmission" and "avoidability" or "preventability" as key terms. Studies that specified causes of unplanned readmissions were included. The causes were classified into eight preliminary root causes: Technical, Organization (integrated care), Organization (hospital department level), Human (care provider), Human (informal caregiver), Patient (self-management), Patient (disease), and Other. The root causes were based on expert opinions and the root cause analysis tool of PRISMA (Prevention and Recovery Information System for Monitoring and Analysis). The range of different causes were analyzed using Microsoft Excel. RESULTS Forty-five studies that reported 381 causes of readmissions were included. All studies reported causes related to organization of care at the hospital department level. These causes were often reported as preventable. Twenty-two studies included causes related to patient's self-management and 19 studies reported causes related to patient's disease. Studies differed in which causes were seen as preventable or unpreventable. None reported causes related to technical failures and causes due to integrated care issues were reported in 18 studies. CONCLUSIONS This review showed that causes for readmissions were mainly evaluated from a hospital perspective. However, causes beyond the scope of the hospital can also play a major role in unplanned readmissions. Opinions regarding preventability seem to depend on contextual factors of the readmission. This study presents a cause classification framework that could help future readmission studies to gain insight into a broad range of causes for readmissions in a patient journey.
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Affiliation(s)
- R. G. Singotani
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands
| | - F. Karapinar
- Department of clinical pharmacy, Onze Lieve Vrouwe Gasthuis (OLVG), location West, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands
| | - C. Brouwers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands
| | - C. Wagner
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands
- Netherlands institute for Health Services research, Otterstraat 118-124, 3513 CR Utrecht, The Netherlands
| | - M. C. de Bruijne
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands
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18
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Basnet S, Zhang M, Lesser M, Wolf-Klein G, Qiu G, Williams M, Pekmezaris R, DiMarzio P. Thirty-day hospital readmission rate amongst older adults correlates with an increased number of medications, but not with Beers medications. Geriatr Gerontol Int 2018; 18:1513-1518. [PMID: 30225904 DOI: 10.1111/ggi.13518] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 06/26/2018] [Accepted: 07/30/2018] [Indexed: 11/30/2022]
Abstract
AIM We sought to explore the relationship between the number of medications at hospital discharge and 30-day rehospitalization in older adults aged >65 years. METHODS This was a multicenter cohort study to determine whether an increased number of medications was associated with 30-day rehospitalization in patients aged >65 years. We explored the relationship between rehospitalization and other risk factors. Data were collected from a large health system in the New York metropolitan area from September 2011 to January 2013. The primary outcome was 30-day hospital readmission from the index hospitalization. RESULTS Patients had a mean ± SD age of 78 ± 9 years; 55% were women. The average length of stay after discharge from the hospital was 6 days. An increased number of medications was significantly associated with unplanned 30-day hospital readmission (P < 0.05). For each medication, the risk of rehospitalization increased by 4% (OR 1.04, 95% CI 1.03, 1.05). Patients discharged to rehabilitation centers were 32% more likely to be readmitted than patients discharged home (OR 1.39, 95% CI 1.27-1.51). Other risk factors significantly associated with 30-day rehospitalization were: cancer, intensive care unit, chronic heart failure, renal diseases and peripheral vascular diseases. Hypertension was negatively associated with 30-day unplanned rehospitalization (OR 0.88, 95% CI 0.82-0.95). No significant association between the number of Beers medications and 30-day rehospitalization was observed, after controlling for the number of medications and other covariates. CONCLUSIONS The number of discharge medications was significantly associated with 30-day hospital readmission among older adult patients. Important risk factors for 30-day rehospitalization were discharge location, cancer, intensive care unit, chronic heart failure, renal diseases and peripheral vascular diseases. Geriatr Gerontol Int 2018; 18: 1513-1518.
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Affiliation(s)
- Suresh Basnet
- Department of Anesthesiology, Division of Critical Care Medicine Washington University School of Medicine, St. Louis, Missouri, USA
| | - Meng Zhang
- Department of Medicine, Hofstra-Northwell Health School of Medicine, Great Neck, New York, USA.,Biostatistics Unit, the Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Martin Lesser
- Biostatistics Unit, the Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Gisele Wolf-Klein
- Department of Geriatrics, Hofstra-Northwell Health School of Medicine, Great Neck, New York, USA
| | - Guang Qiu
- Department of Medicine, Hofstra-Northwell Health School of Medicine, Great Neck, New York, USA
| | - Myia Williams
- Department of Medicine, Hofstra-Northwell Health School of Medicine, Great Neck, New York, USA
| | - Renee Pekmezaris
- Department of Medicine, Hofstra-Northwell Health School of Medicine, Great Neck, New York, USA
| | - Paola DiMarzio
- Department of Medicine, Hofstra-Northwell Health School of Medicine, Great Neck, New York, USA
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19
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Shehab N, Greenwald JL, Budnitz DS. Anticoagulation Across Care Transitions: Identifying Minimum Data to Maximize Drug Safety. Jt Comm J Qual Patient Saf 2018; 44:627-629. [PMID: 30139564 DOI: 10.1016/j.jcjq.2018.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Westberg SM, Yarbrough A, Weinhandl ED, Adam TJ, Brummel AR, Reidt SL, Sick BT, St Peter WL. Drug Therapy Problem Severity Following Hospitalization and Association With 30-Day Clinical Outcomes. Ann Pharmacother 2018; 52:1195-1203. [PMID: 29888615 DOI: 10.1177/1060028018781919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Improved understanding of how drug therapy problems (DTPs) contribute to rehospitalization is needed. OBJECTIVE The primary objectives were to assess the association of DTP likelihood of harm (LoH) severity score, as measured by comprehensive medication management (CMM) pharmacist after hospital discharge, with 30-day risk of hospital readmission, observation visit, or emergency department visit, and to determine whether resolution of DTPs reduces 30-day risk. Secondary objectives were to determine if any eventswere associated with DTPs and preventability of events. METHODS Data were collected for 365 patients who received CMM following hospitalization and had at least 1 DTP identified. Retrospective chart reviews were completed for 80 patients with subsequent events to assess associationg with a DTP and its preventability. RESULTS For each 1-point increment in maximum LoH score, there was 10% higher risk of the composite end point (hazard ratio [HR]=1.10; 95% CI:0.97-1.26; P=0.13). When DTPs were resolved by the CMM pharmacist, the association was attenuated, with a HR of 1.15 (95% CI:0.96-1.38; P=0.12) when the DTP was unresolved and HR of 1.09 (95% CI:0.96-1.25; P=0.52) when resolved; for hospital readmission alone, the corresponding HRs were 1.23 (95% CI:1.00-1.53; P=0.05) and 1.05 (95% CI:0.87-1.27; P=0.60). Of 80 subsequent events, 44 were associated with a medication; 22 were considered preventable. Conclusion and Relevance: The LoH severity score was associated with risk of 30-day events. The strength of association was attenuated when DTPs were resolved by the CMM pharmacist. However, because of statistical uncertainty, larger studies are needed to confirm these patterns.
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Affiliation(s)
- Sarah M Westberg
- 1 University of Minnesota College of Pharmacy, Minneapolis, MN, USA
| | | | - Eric D Weinhandl
- 1 University of Minnesota College of Pharmacy, Minneapolis, MN, USA
| | - Terrence J Adam
- 1 University of Minnesota College of Pharmacy, Minneapolis, MN, USA
| | | | - Shannon L Reidt
- 1 University of Minnesota College of Pharmacy, Minneapolis, MN, USA
| | - Brian T Sick
- 4 University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Wendy L St Peter
- 1 University of Minnesota College of Pharmacy, Minneapolis, MN, USA
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21
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El Morabet N, Uitvlugt EB, van den Bemt BJ, van den Bemt PM, Janssen MJ, Karapinar-Çarkit F. Prevalence and Preventability of Drug-Related Hospital Readmissions: A Systematic Review. J Am Geriatr Soc 2018; 66:602-608. [DOI: 10.1111/jgs.15244] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Najla El Morabet
- Department of Hospital Pharmacy; OLVG; Amsterdam The Netherlands
| | | | - Bart J.F. van den Bemt
- Department of Pharmacy; SintMaartenskliniek; Nijmegen The Netherlands
- Department of Pharmacy; Radboud University Medical Centre; Nijmegen The Netherlands
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22
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Alhawassi TM, Krass I, Pont LG. Antihypertensive-related adverse drug reactions among older hospitalized adults. Int J Clin Pharm 2018; 40:428-435. [PMID: 29392477 DOI: 10.1007/s11096-017-0583-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 12/20/2017] [Indexed: 02/08/2023]
Abstract
Background Antihypertensive medications are commonly used for a wide range of indications, yet it is unknown to what extent older adults are at risk of adverse drug reactions (ADRs) associated with their antihypertensive medication use. Objective The aim of this study was to determine the prevalence and characteristics of antihypertensive-related ADRs on hospital admission. Setting Metropolitan teaching hospital in Sydney, Australia. Method A retrospective cross-sectional audit of 503 older patients (≥ 65 years) admitted to hospital was conducted. Potential ADRS were identified from the medical record. Two independent clinical pharmacists reviewed each potential ADR using validated tools for causality, severity, preventability and contribution to hospitalization. Characteristics associated with an increased ADR risk among antihypertensive users were identified via logistic regression. Main outcome measure Antihypertensive related ADRs. Results Antihypertensives were used on admission by 68% of the cohort and the prevalence of 'definite/probable' antihypertensive-related ADRs among antihypertensive users was 16.4%. Antihypertensive medications were associated with a threefold ADR risk (OR = 3.09, 95% CI 1.85-5.16). Angiotensin II Receptor Blockers (ARB), impaired renal function, recent medication changes and previous history of allergy or ADR were all associated with an increased risk of experiencing an ADR. Conclusions ADRS associated with antihypertensive medicines were relatively common among older adults admitted to hospital. Increased awareness of those older persons who are most at risk of experiencing an antihypertensive-related ADR in the clinical setting may lead to early detection and minimization of ADR associated harms.
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Affiliation(s)
- Tariq M Alhawassi
- King Saud University, Riyadh, Saudi Arabia.,University of Sydney, Sydney, NSW, Australia
| | - Ines Krass
- University of Sydney, Sydney, NSW, Australia
| | - Lisa G Pont
- University of Technology Sydney, Sydney, NSW, Australia.
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23
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Pellegrin KL, Lee E, Uyeno R, Ayson C, Goo R. Potentially preventable medication-related hospitalizations: A clinical pharmacist approach to assessment, categorization, and quality improvement. J Am Pharm Assoc (2003) 2017; 57:711-716. [DOI: 10.1016/j.japh.2017.06.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/30/2017] [Accepted: 06/24/2017] [Indexed: 10/19/2022]
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24
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Feng X, Tan X, Riley B, Zheng T, Bias T, Sambamoorthi U. Polypharmacy and Multimorbidity Among Medicaid Enrollees: A Multistate Analysis. Popul Health Manag 2017; 21:123-129. [PMID: 28683221 DOI: 10.1089/pop.2017.0065] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of this study is to explore the associations between polypharmacy and multimorbidity using conventional and novel measures of polypharmacy. In this cross-sectional study, data on fee-for-service (FFS) Medicaid enrollees with at least 1 chronic condition and aged 18-64 years (N = 38,329) were derived from the 2010 Medicaid Analytic eXtract (MAX) files of Maryland and West Virginia. Polypharmacy, by the authors' novel definition, was determined as simultaneous use of ≥5 drugs for a consecutive period of 60 days. Multimorbidity was defined as having ≥2 chronic conditions based on the US Department of Health and Human Services framework. The association between multimorbidity and polypharmacy was examined with chi-square tests and logistic regression. Polypharmacy prevalence was estimated at 50.9% using the novel definition, as compared to 16.7% and 64.9% for the 2 commonly used conventional measures, respectively. For all 3 definitions, individuals with multimorbidity were more likely to have polypharmacy than those without multimorbidity (P < 0.001). The authors also consistently found, using all definitions, that those who were older, female, white, and eligible for Medicaid because of cash assistance were more likely to have polypharmacy (all P < 0.001). Polypharmacy was highly prevalent and significantly associated with multimorbidity among Medicaid FFS enrollees irrespective of the definitions used. The new measure may provide a more comprehensive and accurate estimation of polypharmacy than the conventional measures. These findings suggest the need for a paradigm shift from disease-specific care to patient-centered collaborative care to manage patients with multimorbidity and polypharmacy.
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Affiliation(s)
- Xue Feng
- 1 Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University , Morgantown, West Virginia
| | - Xi Tan
- 1 Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University , Morgantown, West Virginia
| | - Brittany Riley
- 2 Department of Pharmacy Practice, Administration and Research, School of Pharmacy, Marshall University , Huntington, West Virginia
| | - Tianyu Zheng
- 1 Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University , Morgantown, West Virginia
| | - Thomas Bias
- 3 Department of Health Policy, Management, and Leadership, School of Public Health, West Virginia University , Morgantown, West Virginia
| | - Usha Sambamoorthi
- 1 Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University , Morgantown, West Virginia
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Morath B, Mayer T, Send AFJ, Hoppe-Tichy T, Haefeli WE, Seidling HM. Risk factors of adverse health outcomes after hospital discharge modifiable by clinical pharmacist interventions: a review with a systematic approach. Br J Clin Pharmacol 2017; 83:2163-2178. [PMID: 28452063 DOI: 10.1111/bcp.13318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 12/19/2022] Open
Abstract
The present review assessed the evidence on risk factors for the occurrence of adverse health outcomes after discharge (i.e. unplanned readmission or adverse drug event after discharge) that are potentially modifiable by clinical pharmacist interventions. The findings were compared with patient characteristics reported in guidelines that supposedly indicate a high risk of drug-related problems. First, guidelines and risk assessment tools were searched for patient characteristics indicating a high risk of drug-related problems. Second, a systematic PubMed search was conducted to identify risk factors significantly associated with adverse health outcomes after discharge that are potentially modifiable by a clinical pharmacist intervention. After the PubMed search, 37 studies were included, reporting 16 risk factors. Only seven of 34 patient characteristics mentioned in pertinent guidelines corresponded to one of these risk factors. Diabetes mellitus (n = 11), chronic obstructive lung disease (n = 9), obesity (n = 7), smoking (n = 5) and polypharmacy (n = 5) were the risk factors reported most frequently in the studies. Additionally, single studies also found associations of adverse health outcomes with different drug classes {e.g. warfarin [hazard ratio 1.50; odds ratio (OR) 3.52], furosemide [OR 2.25] or high beta-blocker starting doses [OR 3.10]}. Although several modifiable risk factors were found, many patient characteristics supposedly indicating a high risk of drug-related problems were not part of the assessed risk factors in the context of an increased risk of adverse health outcomes after discharge. Therefore, an obligatory set of modifiable patient characteristics should be created and implemented in future studies investigating the risk for adverse health outcomes after discharge.
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Affiliation(s)
- Benedict Morath
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Hospital Pharmacy, Heidelberg University, Im Neuenheimer Feld 670, 69120, Heidelberg, Germany
| | - Tanja Mayer
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Alexander Francesco Josef Send
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Torsten Hoppe-Tichy
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Hospital Pharmacy, Heidelberg University, Im Neuenheimer Feld 670, 69120, Heidelberg, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hanna Marita Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Kerstenetzky L, Birschbach MJ, Beach KF, Hager DR, Kennelty KA. Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: A targeted needs assessment using the Intervention Mapping framework. Res Social Adm Pharm 2017; 14:138-145. [PMID: 28455194 DOI: 10.1016/j.sapharm.2016.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/01/2016] [Accepted: 12/16/2016] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Patients transitioning from the hospital to a skilled nursing home (SNF) are susceptible to medication-related errors resulting from fragmented communication between facilities. Through continuous process improvement efforts at the hospital, a targeted needs assessment was performed to understand the extent of medication-related issues when patients transition from the hospital into a SNF, and the gaps between the hospital's discharge process, and the needs of the SNF and long-term care (LTC) pharmacy. We report on the development of a logic model that will be used to explore methods for minimizing patient care medication delays and errors while further improving handoff communication to SNF and LTC pharmacy staff. METHODS Applying the Intervention Mapping (IM) framework, a targeted needs assessment was performed using quantitative and qualitative methods. Using the hospital discharge medication list as reference, medication discrepancies in the SNF and LTC pharmacy lists were identified. SNF and LTC pharmacy staffs were also interviewed regarding the continuity of medication information post-discharge from the hospital. RESULTS At least one medication discrepancy was discovered in 77.6% (n = 45/58) of SNF and 76.0% (n = 19/25) of LTC pharmacy medication lists. A total of 191 medication discrepancies were identified across all SNF and LTC pharmacy records. Of the 69 SNF staff interviewed, 20.3% (n = 14) reported patient care delays due to omitted documents during the hospital-to-SNF transition. During interviews, communication between the SNF/LTC pharmacy and the discharging hospital was described by facility staff as unidirectional with little opportunity for feedback on patient care concerns. CONCLUSIONS The targeted needs assessment guided by the IM framework has lent to several planned process improvements initiatives to help reduce medication discrepancies during the hospital-to-SNF transition as well as improve communication between healthcare entities. Opening lines of communication along with aligning healthcare entity goals may help prevent medication-related errors.
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Affiliation(s)
- Luiza Kerstenetzky
- UW Health - Department of Pharmacy, 600 Highland Avenue, Madison, WI, 53792, United States.
| | - Matthew J Birschbach
- UW Health - Department of Pharmacy, 600 Highland Avenue, Madison, WI, 53792, United States; University of Wisconsin - Madison, School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, United States.
| | - Katherine F Beach
- UW Health - Department of Pharmacy, 600 Highland Avenue, Madison, WI, 53792, United States; University of Wisconsin - Madison, School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, United States.
| | - David R Hager
- UW Health - Department of Pharmacy, 600 Highland Avenue, Madison, WI, 53792, United States.
| | - Korey A Kennelty
- University of Wisconsin - Madison, School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, United States; Department of Pharmacy Practice and Science, University of Iowa, College of Pharmacy, 115 S Grand Ave, Iowa City, IA, 52242, United States.
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Khandeparkar A, Rataboli PV. A study of harmful drug-drug interactions due to polypharmacy in hospitalized patients in Goa Medical College. Perspect Clin Res 2017; 8:180-186. [PMID: 29109936 PMCID: PMC5654218 DOI: 10.4103/picr.picr_132_16] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introduction: Concomitant use of multiple drugs is often indicated to manage comorbid conditions and enhance efficacy. Such concomitant use of multiple drugs (five or more drugs) has been defined as “polypharmacy.” Polypharmacy has been associated with adverse consequences such as greater healthcare costs, increased risk of adverse drug events, drug–drug interactions (DDIs), medication nonadherence, reduced functional capacity, and multiple geriatric syndromes. This study evaluated number of potential harmful DDIs due to polypharmacy. Materials and Methods: A prospective, cross-sectional, observational study was performed from July 2011 to June 2012. Approval was obtained from the Institutional Ethics Committee, Goa Medical College. Drug interactions were identified using a computerized DDI database system Lexi-Comp version: 2.4.1. Quantitative data analysis was done by the SPSS for Windows version 17.0. Results: Seven hundred and fifty-one out of 5424 (13.85%) prescriptions were observed to have polypharmacy with highest rates observed in the Department of Medicine. The median age of patients was 55.60 ± 13.86 (range 10–108 years). A total number of drugs per prescription ranged from minimum of 5 to maximum of 16 drugs, with an average of 7.96 ± 1.75. A large number of 596 prescriptions contained 6–9 drugs per prescription. Drugs involved in potential DDIs in our study included aspirin, antacids, beta-blockers, 3-hydroxy-3-methylglutaryl-coenzyme reductase inhibitors, calcium channel blockers, angiotensin-converting enzyme inhibitors, ondansetron, and H2 blockers. Conclusion: Patients taking multiple medications experience unique pharmacotherapy. Personalized drug prescribing strategies and close monitoring of patients taking drugs with potential DDIs are keys to optimal therapeutic result.
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Affiliation(s)
- Akshay Khandeparkar
- Department of Medical Affairs, Roche Pharmaceuticals, Mumbai, Maharashtra, India
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28
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Hospitalizations due to preventable adverse reactions—a systematic review. Eur J Clin Pharmacol 2016; 73:385-398. [PMID: 27913837 DOI: 10.1007/s00228-016-2170-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
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Abou-Karam N, Bradford C, Lor KB, Barnett M, Ha M, Rizos A. Medication regimen complexity and readmissions after hospitalization for heart failure, acute myocardial infarction, pneumonia, and chronic obstructive pulmonary disease. SAGE Open Med 2016; 4:2050312116632426. [PMID: 26985392 PMCID: PMC4778087 DOI: 10.1177/2050312116632426] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/13/2016] [Indexed: 01/24/2023] Open
Abstract
Objectives: Readmission rate is increasingly being viewed as a key indicator of health system performance. Medication regimen complexity index scores may be predictive of readmissions; however, few studies have examined this potential association. The primary objective of this study was to determine whether medication regimen complexity index is associated with all-cause 30-day readmission after admission for heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease. Methods: This study was an institutional review board–approved, multi-center, case–control study. Patients admitted with a primary diagnosis of heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease were randomly selected for inclusion. Patients were excluded if they discharged against medical advice or expired during their index visit. Block randomization was utilized for equal representation of index diagnosis and site. Discharge medication regimen complexity index scores were compared between subjects with readmission versus those without. Medication regimen complexity index score was then used as a predictor in logistic regression modeling for readmission. Results: Seven hundred and fifty-six patients were randomly selected for inclusion, and 101 (13.4%) readmitted within 30 days. The readmission group had higher medication regimen complexity index scores than the no-readmission group (p < 0.01). However, after controlling for demographics, disease state, length of stay, site, and medication count, medication regimen complexity index was no longer a significant predictor of readmission (odds ratio 0.99, 95% confidence interval 0.97–1.01) or revisit (odds ratio 0.99, 95% confidence interval 0.98–1.02). Conclusion: There is little evidence to support the use of medication regimen complexity index in readmission prediction when other measures are available. Medication regimen complexity index may lack sufficient sensitivity to capture an effect of medication regimen complexity on all-cause readmission.
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Affiliation(s)
- Nada Abou-Karam
- Department of Pharmacy Services, Sharp Memorial Hospital, San Diego, CA, USA; Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, CA, USA
| | - Chad Bradford
- Department of Pharmacy Services, Sharp Memorial Hospital, San Diego, CA, USA; Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, CA, USA
| | - Kajua B Lor
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, CA, USA
| | - Mitchell Barnett
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, CA, USA
| | - Michelle Ha
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA
| | - Albert Rizos
- System Pharmacy Services, Sharp Healthcare, San Diego, CA, USA
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30
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Dreyer RP, Ranasinghe I, Wang Y, Dharmarajan K, Murugiah K, Nuti SV, Hsieh AF, Spertus JA, Krumholz HM. Sex Differences in the Rate, Timing, and Principal Diagnoses of 30-Day Readmissions in Younger Patients with Acute Myocardial Infarction. Circulation 2015; 132:158-66. [PMID: 26085455 DOI: 10.1161/circulationaha.114.014776] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Young women (<65 years) experience a 2- to 3-fold greater mortality risk than younger men after an acute myocardial infarction. However, it is unknown whether they are at higher risk for 30-day readmission, and if this association varies by age. We examined sex differences in the rate, timing, and principal diagnoses of 30-day readmissions, including the independent effect of sex following adjustment for confounders. METHODS AND RESULTS We included patients aged 18 to 64 years with a principal diagnosis of acute myocardial infarction. Data were used from the Healthcare Cost and Utilization Project-State Inpatient Database for California (07-09). Readmission diagnoses were categorized by using an aggregated version of the Centers for Medicare and Medicaid Services' Condition Categories, and readmission timing was determined from the day after discharge. Of 42,518 younger patients with acute myocardial infarction (26.4% female), 4775 (11.2%) had at least 1 readmission. The 30-day all-cause readmission rate was higher for women (15.5% versus 9.7%, P<0.0001). For both sexes, readmission risk was highest on days 2 to 4 after discharge and declined thereafter, and women were more likely to present with noncardiac diagnoses (44.4% versus 40.6%, P=0.01). Female sex was associated with a higher rate of 30-day readmission, which persisted after adjustment (hazard ratio, 1.22; 95% confidence interval, 1.15-1.30). There was no significant interaction between age and sex on readmission. CONCLUSIONS In comparison with men, younger women have a higher risk for readmission, even after the adjustment for confounders. The timing of 30-day readmission was similar in women and men, and both sexes were susceptible to a wide range of causes for readmission.
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Affiliation(s)
- Rachel P Dreyer
- From the Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT (R.P.D., I.R., Y.W., K.D., K.M., S.V.N., A.F.H., H.M.K.); Section of Cardiovascular Medicine (R.P.D., I.R., Y.W., K.D., S.V.N., H.M.K.) and the Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), New Haven, CT; Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Adelaide SA (I.R.); Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, MO (J.A.S.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.). Dr Ranasinghe was affiliated with the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Section of Cardiovascular Medicine, New Haven, CT during the time the work was conducted.
| | - Isuru Ranasinghe
- From the Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT (R.P.D., I.R., Y.W., K.D., K.M., S.V.N., A.F.H., H.M.K.); Section of Cardiovascular Medicine (R.P.D., I.R., Y.W., K.D., S.V.N., H.M.K.) and the Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), New Haven, CT; Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Adelaide SA (I.R.); Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, MO (J.A.S.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.). Dr Ranasinghe was affiliated with the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Section of Cardiovascular Medicine, New Haven, CT during the time the work was conducted
| | - Yongfei Wang
- From the Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT (R.P.D., I.R., Y.W., K.D., K.M., S.V.N., A.F.H., H.M.K.); Section of Cardiovascular Medicine (R.P.D., I.R., Y.W., K.D., S.V.N., H.M.K.) and the Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), New Haven, CT; Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Adelaide SA (I.R.); Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, MO (J.A.S.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.). Dr Ranasinghe was affiliated with the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Section of Cardiovascular Medicine, New Haven, CT during the time the work was conducted
| | - Kumar Dharmarajan
- From the Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT (R.P.D., I.R., Y.W., K.D., K.M., S.V.N., A.F.H., H.M.K.); Section of Cardiovascular Medicine (R.P.D., I.R., Y.W., K.D., S.V.N., H.M.K.) and the Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), New Haven, CT; Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Adelaide SA (I.R.); Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, MO (J.A.S.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.). Dr Ranasinghe was affiliated with the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Section of Cardiovascular Medicine, New Haven, CT during the time the work was conducted
| | - Karthik Murugiah
- From the Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT (R.P.D., I.R., Y.W., K.D., K.M., S.V.N., A.F.H., H.M.K.); Section of Cardiovascular Medicine (R.P.D., I.R., Y.W., K.D., S.V.N., H.M.K.) and the Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), New Haven, CT; Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Adelaide SA (I.R.); Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, MO (J.A.S.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.). Dr Ranasinghe was affiliated with the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Section of Cardiovascular Medicine, New Haven, CT during the time the work was conducted
| | - Sudhakar V Nuti
- From the Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT (R.P.D., I.R., Y.W., K.D., K.M., S.V.N., A.F.H., H.M.K.); Section of Cardiovascular Medicine (R.P.D., I.R., Y.W., K.D., S.V.N., H.M.K.) and the Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), New Haven, CT; Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Adelaide SA (I.R.); Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, MO (J.A.S.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.). Dr Ranasinghe was affiliated with the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Section of Cardiovascular Medicine, New Haven, CT during the time the work was conducted
| | - Angela F Hsieh
- From the Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT (R.P.D., I.R., Y.W., K.D., K.M., S.V.N., A.F.H., H.M.K.); Section of Cardiovascular Medicine (R.P.D., I.R., Y.W., K.D., S.V.N., H.M.K.) and the Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), New Haven, CT; Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Adelaide SA (I.R.); Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, MO (J.A.S.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.). Dr Ranasinghe was affiliated with the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Section of Cardiovascular Medicine, New Haven, CT during the time the work was conducted
| | - John A Spertus
- From the Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT (R.P.D., I.R., Y.W., K.D., K.M., S.V.N., A.F.H., H.M.K.); Section of Cardiovascular Medicine (R.P.D., I.R., Y.W., K.D., S.V.N., H.M.K.) and the Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), New Haven, CT; Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Adelaide SA (I.R.); Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, MO (J.A.S.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.). Dr Ranasinghe was affiliated with the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Section of Cardiovascular Medicine, New Haven, CT during the time the work was conducted
| | - Harlan M Krumholz
- From the Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT (R.P.D., I.R., Y.W., K.D., K.M., S.V.N., A.F.H., H.M.K.); Section of Cardiovascular Medicine (R.P.D., I.R., Y.W., K.D., S.V.N., H.M.K.) and the Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), New Haven, CT; Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Adelaide SA (I.R.); Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, MO (J.A.S.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.). Dr Ranasinghe was affiliated with the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Section of Cardiovascular Medicine, New Haven, CT during the time the work was conducted
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Anderegg SV, Wilkinson ST, Couldry RJ, Grauer DW, Howser E. Effects of a hospitalwide pharmacy practice model change on readmission and return to emergency department rates. Am J Health Syst Pharm 2015; 71:1469-79. [PMID: 25147171 DOI: 10.2146/ajhp130686] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The impact of an innovative medication reconciliation and discharge education program on 30-day readmissions and emergency department (ED) visits was evaluated. METHODS An observational pre-post analysis was conducted at an academic medical center to compare rates of hospital readmissions and return to ED visits during three-month periods before and after implementation of a restructured pharmacy practice model including (1) medication reconciliation at transitions of care for every patient and discharge education for a high-risk subgroup, (2) new or expanded services in the preanesthesia testing clinic and ED, (3) a medication reconciliation technician team, and (4) pharmacist-to-patient ratios of 1:30 on acute care floors and 1:18 on critical care units. The primary outcome was the composite of rates of readmissions and return to ED visits within 30 days of discharge. RESULTS A total of 3,316 patients were included in the study. Pharmacy teams completed medication reconciliation in 95.8% of cases at admission and 69.7% of cases at discharge. Discharge education was provided to 73.5% of high-risk patients (defined as those receiving anticoagulation therapy or treatment for acute myocardial infarction, chronic obstructive pulmonary disease, congestive heart failure, or pneumonia). No significant difference was observed between the preimplementation and postimplementation groups with regard to the primary outcome. In the high-risk subgroup, there was a significant reduction in the 30-day rate of hospital readmissions, which declined from 17.8% to 12.3% (p=0.042); cost projections indicated that this reduction in readmissions could yield annual direct cost savings of more than $780,000. CONCLUSION Implementation of a team-based pharmacy practice model resulted in a significant decrease in the rate of 30-day readmissions for high-risk patients.
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Affiliation(s)
- Sammuel V Anderegg
- Sammuel V. Anderegg, Pharm.D., M.S., BCPS, is Pharmacy Manager, Oncology Service Line, Georgia Regents Medical Center, Augusta, GA; at the time of writing, he was Postgraduate Year 2 Health-System Pharmacy Administration Resident, The University of Kansas Hospital (UKH), Kansas City, and University of Kansas School of Pharmacy, Lawrence. Samaneh T. Wilkinson, Pharm.D., M.S., is Assistant Director of Pharmacy, Clinical Services; and Rick J. Couldry, B.S.Pharm., M.S., FASHP, is Director of Pharmacy, UKH. Dennis W. Grauer, M.S., Ph.D., is Associate Professor and Graduate Program Director, University of Kansas School of Pharmacy. Eric Howser is Decision Support Systems Specialist, UKH.
| | - Samaneh T Wilkinson
- Sammuel V. Anderegg, Pharm.D., M.S., BCPS, is Pharmacy Manager, Oncology Service Line, Georgia Regents Medical Center, Augusta, GA; at the time of writing, he was Postgraduate Year 2 Health-System Pharmacy Administration Resident, The University of Kansas Hospital (UKH), Kansas City, and University of Kansas School of Pharmacy, Lawrence. Samaneh T. Wilkinson, Pharm.D., M.S., is Assistant Director of Pharmacy, Clinical Services; and Rick J. Couldry, B.S.Pharm., M.S., FASHP, is Director of Pharmacy, UKH. Dennis W. Grauer, M.S., Ph.D., is Associate Professor and Graduate Program Director, University of Kansas School of Pharmacy. Eric Howser is Decision Support Systems Specialist, UKH
| | - Rick J Couldry
- Sammuel V. Anderegg, Pharm.D., M.S., BCPS, is Pharmacy Manager, Oncology Service Line, Georgia Regents Medical Center, Augusta, GA; at the time of writing, he was Postgraduate Year 2 Health-System Pharmacy Administration Resident, The University of Kansas Hospital (UKH), Kansas City, and University of Kansas School of Pharmacy, Lawrence. Samaneh T. Wilkinson, Pharm.D., M.S., is Assistant Director of Pharmacy, Clinical Services; and Rick J. Couldry, B.S.Pharm., M.S., FASHP, is Director of Pharmacy, UKH. Dennis W. Grauer, M.S., Ph.D., is Associate Professor and Graduate Program Director, University of Kansas School of Pharmacy. Eric Howser is Decision Support Systems Specialist, UKH
| | - Dennis W Grauer
- Sammuel V. Anderegg, Pharm.D., M.S., BCPS, is Pharmacy Manager, Oncology Service Line, Georgia Regents Medical Center, Augusta, GA; at the time of writing, he was Postgraduate Year 2 Health-System Pharmacy Administration Resident, The University of Kansas Hospital (UKH), Kansas City, and University of Kansas School of Pharmacy, Lawrence. Samaneh T. Wilkinson, Pharm.D., M.S., is Assistant Director of Pharmacy, Clinical Services; and Rick J. Couldry, B.S.Pharm., M.S., FASHP, is Director of Pharmacy, UKH. Dennis W. Grauer, M.S., Ph.D., is Associate Professor and Graduate Program Director, University of Kansas School of Pharmacy. Eric Howser is Decision Support Systems Specialist, UKH
| | - Eric Howser
- Sammuel V. Anderegg, Pharm.D., M.S., BCPS, is Pharmacy Manager, Oncology Service Line, Georgia Regents Medical Center, Augusta, GA; at the time of writing, he was Postgraduate Year 2 Health-System Pharmacy Administration Resident, The University of Kansas Hospital (UKH), Kansas City, and University of Kansas School of Pharmacy, Lawrence. Samaneh T. Wilkinson, Pharm.D., M.S., is Assistant Director of Pharmacy, Clinical Services; and Rick J. Couldry, B.S.Pharm., M.S., FASHP, is Director of Pharmacy, UKH. Dennis W. Grauer, M.S., Ph.D., is Associate Professor and Graduate Program Director, University of Kansas School of Pharmacy. Eric Howser is Decision Support Systems Specialist, UKH
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El Hajji FWD, Scullin C, Scott MG, McElnay JC. Enhanced clinical pharmacy service targeting tools: risk-predictive algorithms. J Eval Clin Pract 2015; 21:187-97. [PMID: 25496483 DOI: 10.1111/jep.12276] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2014] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES This study aimed to determine the value of using a mix of clinical pharmacy data and routine hospital admission spell data in the development of predictive algorithms. Exploration of risk factors in hospitalized patients, together with the targeting strategies devised, will enable the prioritization of clinical pharmacy services to optimize patient outcomes. METHODS Predictive algorithms were developed using a number of detailed steps using a 75% sample of integrated medicines management (IMM) patients, and validated using the remaining 25%. IMM patients receive targeted clinical pharmacy input throughout their hospital stay. The algorithms were applied to the validation sample, and predicted risk probability was generated for each patient from the coefficients. Risk threshold for the algorithms were determined by identifying the cut-off points of risk scores at which the algorithm would have the highest discriminative performance. Clinical pharmacy staffing levels were obtained from the pharmacy department staffing database. RESULTS Numbers of previous emergency admissions and admission medicines together with age-adjusted co-morbidity and diuretic receipt formed a 12-month post-discharge and/or readmission risk algorithm. Age-adjusted co-morbidity proved to be the best index to predict mortality. Increased numbers of clinical pharmacy staff at ward level was correlated with a reduction in risk-adjusted mortality index (RAMI). CONCLUSIONS Algorithms created were valid in predicting risk of in-hospital and post-discharge mortality and risk of hospital readmission 3, 6 and 12 months post-discharge. The provision of ward-based clinical pharmacy services is a key component to reducing RAMI and enabling the full benefits of pharmacy input to patient care to be realized.
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Affiliation(s)
- Feras W D El Hajji
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
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Abstract
The estimated cost for hospital readmissions in 2011 was more than $41 billion, but the costs to patients in terms of quality of life are immeasurable. The purpose of this study was to determine if there are variables available to nurses at the time of the patient's admission that could be predictive of a 30-day hospital readmission. Logistic regression was used in a stepwise approach to determine the variable combinations most predictive for 30-day readmission. Thirty-two variables were found to be significantly predictive of 30-day readmissions from the more than 1400 examined.
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Hebert C, Shivade C, Foraker R, Wasserman J, Roth C, Mekhjian H, Lemeshow S, Embi P. Diagnosis-specific readmission risk prediction using electronic health data: a retrospective cohort study. BMC Med Inform Decis Mak 2014; 14:65. [PMID: 25091637 PMCID: PMC4136398 DOI: 10.1186/1472-6947-14-65] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Readmissions after hospital discharge are a common occurrence and are costly for both hospitals and patients. Previous attempts to create universal risk prediction models for readmission have not met with success. In this study we leveraged a comprehensive electronic health record to create readmission-risk models that were institution- and patient- specific in an attempt to improve our ability to predict readmission. METHODS This is a retrospective cohort study performed at a large midwestern tertiary care medical center. All patients with a primary discharge diagnosis of congestive heart failure, acute myocardial infarction or pneumonia over a two-year time period were included in the analysis.The main outcome was 30-day readmission. Demographic, comorbidity, laboratory, and medication data were collected on all patients from a comprehensive information warehouse. Using multivariable analysis with stepwise removal we created three risk disease-specific risk prediction models and a combined model. These models were then validated on separate cohorts. RESULTS 3572 patients were included in the derivation cohort. Overall there was a 16.2% readmission rate. The acute myocardial infarction and pneumonia readmission-risk models performed well on a random sample validation cohort (AUC range 0.73 to 0.76) but less well on a historical validation cohort (AUC 0.66 for both). The congestive heart failure model performed poorly on both validation cohorts (AUC 0.63 and 0.64). CONCLUSIONS The readmission-risk models for acute myocardial infarction and pneumonia validated well on a contemporary cohort, but not as well on a historical cohort, suggesting that models such as these need to be continuously trained and adjusted to respond to local trends. The poor performance of the congestive heart failure model may suggest that for chronic disease conditions social and behavioral variables are of greater importance and improved documentation of these variables within the electronic health record should be encouraged.
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Affiliation(s)
- Courtney Hebert
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
- Division of Infectious Diseases, The Ohio State University, Columbus, OH, USA
| | - Chaitanya Shivade
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, USA
| | - Randi Foraker
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Jared Wasserman
- College of Public Health, The Ohio State University, Columbus, OH, USA
- The Dartmouth Institute of Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Caryn Roth
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Hagop Mekhjian
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University, Columbus, OH, USA
| | - Stanley Lemeshow
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Peter Embi
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
- Division of Immunology and Rheumatology, The Ohio State University, Columbus, OH, USA
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Pavon JM, Zhao Y, McConnell E, Hastings SN. Identifying risk of readmission in hospitalized elderly adults through inpatient medication exposure. J Am Geriatr Soc 2014; 62:1116-21. [PMID: 24802165 DOI: 10.1111/jgs.12829] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To use electronic health record (EHR) data to examine the association between inpatient medication exposure and risk of hospital readmission. DESIGN Retrospective, observational study. SETTING Tertiary and quaternary care academic health system in Durham, North Carolina. PARTICIPANTS All individuals aged 60 and older who were residents of Durham County, North Carolina and were hospitalized and discharged alive from Duke University Hospital between 2007 and 2009 (N = 4,627). MEASUREMENTS Independent variables were inpatient exposure to individual medication classes. Primary outcome was readmission to a Duke Health System hospital within 30 days. RESULTS Readmission rate was 21% (n = 955). In adjusted models, exposure to anticonvulsants (odds ratio OR 1.26, 95% confidence interval (CI) = 1.08-1.48), benzodiazepines (OR = 1.23, 95% CI = 1.04-1.44), corticosteroids (OR = 1.26, 95% CI = 1.07-1.50), and opioids (OR = 1.25, 95% CI = 1.06-1.47) was associated with greater likelihood of readmission. Exposure to antidepressants (OR = 1.85, 95% CI = 1.16-2.96) and opioids on the cardiology service (OR = 1.76, 95% CI = 1.01-3.07) and exposure to opioids on the medicine service (OR = 1.94, 95% CI = 1.17-3.22) were associated with greater odds of readmission than for individuals on the surgery service. CONCLUSION Exposure of hospitalized elderly adults to certain medication classes was associated with greater likelihood of readmission. Incorporating medication data from EHRs may improve the performance of hospital readmission prediction models.
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Affiliation(s)
- Juliessa M Pavon
- Division of Geriatrics, Duke University Medical Center, Durham, North Carolina; Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
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Islam T, O'Connell B, Hawkins M. Factors associated with transfers from healthcare facilities among readmitted older adults with chronic illness. AUST HEALTH REV 2014; 38:354-62. [PMID: 24670934 DOI: 10.1071/ah13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 01/09/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Because chronic illness accounts for a considerable proportion of Australian healthcare expenditure, there is a need to identify factors that may reduce hospital readmissions for patients with chronic illness. The aim of the present study was to examine a range of factors potentially associated with transfer from healthcare facilities among older adults readmitted to hospital within a large public health service in Melbourne, Australia. METHODS Data on readmitted patients between June 2006 and June 2011 were extracted from hospital databases and medical records. Adopting a retrospective case-control study design, a sample of 51 patients transferred from private residences was matched by age and gender with 55 patients transferred from healthcare facilities (including nursing homes and acute care facilities). Univariate and multivariate logistic regression analyses were used to compare the two groups, and to determine associations between 46 variables and transfer from a healthcare facility. RESULTS Univariate analysis indicated that patients readmitted from healthcare facilities were significantly more likely to experience relative socioeconomic advantage, disorientation on admission, dementia diagnosis, incontinence and poor skin integrity than those readmitted from a private residence. Three of these variables remained significantly associated with admission from healthcare facilities after multivariate analysis: relative socioeconomic advantage (odds ratio (OR) 11.30; 95% confidence interval (CI) 2.62-48.77), incontinence (OR 7.18; 95% CI 1.19-43.30) and poor skin integrity (OR 18.05; 95% CI 1.85-176.16). CONCLUSIONS Older adults with chronic illness readmitted to hospital from healthcare facilities are significantly more likely to differ from those readmitted from private residences in terms of relative socioeconomic advantage, incontinence and skin integrity. The findings direct efforts towards addressing the apparent disparity in management of patients admitted from a facility as opposed to a private residence.
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Affiliation(s)
- Tasneem Islam
- Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Beverly O'Connell
- Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Mary Hawkins
- Centre for Nursing Research, Deakin University and Monash Health Partnership, Locked Bag 29, Clayton South, Vic. 3169, Australia.
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Salih SB, Yousuf M, Durihim H, Almodaimegh H, Tamim H. Prevalence and associated factors of polypharmacy among adult Saudi medical outpatients at a tertiary care center. J Family Community Med 2014; 20:162-7. [PMID: 24672273 PMCID: PMC3957169 DOI: 10.4103/2230-8229.121987] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: The objective of this study was to assess the prevalence of polypharmacy (PP) and the associated factors in medical outpatients. Materials and Methods: A cross-sectional, observational, descriptive study was carried out in adult medical outpatients attending internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 1 March 2009 to 31 December 2009. PP was defined as the concomitant use of ≥5 medications daily. The number of medications being currently taken by patient was recorded. Effect of patients’ age, gender, educational level, number of prescribers, disease load and disease type on PP was assessed by multivariate analysis using Statistical Package for Social Sciences Incorporated (SPSS Inc) Version 18. Results: Out of 766 patients included in the study, 683 (89%) had PP. The mean number of prescribed medications, oral pills and doses was 8.8, 9.6 and 12.1, respectively. Factors significantly associated with PP included age (≥61 years), disease load and the number of prescribers. Gender had no impact on PP while education beyond primary education significantly decreased PP. Hypertension, diabetes mellitus and dyslipidemia alone and as a cluster increased PP. Conclusion: We found an extremely high level of PP in medical outpatients at our tertiary care center. The impact of PP on medication compliance and control of underlying diseases in Saudi Arabia is unknown and needs to be studied at different levels of care.
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Affiliation(s)
- Salih Bin Salih
- Department of Medicine, College of Medicine, King Abdulaziz Medical City and King Saud Bin Abulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Muhammad Yousuf
- Department of Medicine, College of Medicine, King Abdulaziz Medical City and King Saud Bin Abulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Huda Durihim
- Department of Medicine, College of Medicine, King Abdulaziz Medical City and King Saud Bin Abulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hind Almodaimegh
- Department of Clinical Pharmacy, College of Medicine, King Abdulaziz Medical City and King Saud Bin Abulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hani Tamim
- Department of Medical Education, College of Medicine, King Abdulaziz Medical City and King Saud Bin Abulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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Torisson G, Minthon L, Stavenow L, Londos E. Multidisciplinary intervention reducing readmissions in medical inpatients: a prospective, non-randomized study. Clin Interv Aging 2013; 8:1295-304. [PMID: 24106422 PMCID: PMC3791960 DOI: 10.2147/cia.s49133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine whether a multidisciplinary intervention targeting drug-related problems, cognitive impairment, and discharge miscommunication could reduce readmissions in a general hospital population. METHODS This prospective, non-randomized intervention study was carried out at the department of general internal medicine at a tertiary university hospital. Two hundred medical inpatients living in the community and aged over 60 years were included. Ninety-nine patients received interventions and 101 received standard care. Control/intervention allocation was determined by geographic selection. Interventions consisted of a comprehensive medication review, improved discharge planning, post-discharge telephone follow-up, and liaison with the patient's general practitioner. The main outcome measures recorded were readmissions and hospital nights 12 months after discharge. Separate analyses were made for 12-month survivors and from an intention-to-treat perspective. Comparative analyses were made between groups as well as within groups over time. RESULTS After 12 months, survivors in the control group had 125 readmissions in total, compared with 58 in the intervention group (Mann-Whitney U test, P = 0.02). For hospital nights, the numbers were 1,228 and 492, respectively (P = 0.009). Yearly admissions had increased from the previous year in the control group from 77 to 125 (Wilcoxon signed-rank test, P = 0.002) and decreased from 75 to 58 in the intervention group (P = 0.25). From the intention-to-treat perspective, the same general pattern was observed but was not significant (1,827 versus 1,008 hospital nights, Mann-Whitney test, P = 0.054). CONCLUSION A multidisciplinary approach, targeting several different areas, could substantially lower readmissions and hospital costs in a non-terminal general hospital population.
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Affiliation(s)
- Gustav Torisson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Ryan J, Andrews R, Barry MB, Kang S, Iskandar A, Mehla P, Ganeshan R. Preventability of 30-Day Readmissions for Heart Failure Patients Before and After a Quality Improvement Initiative. Am J Med Qual 2013; 29:220-6. [DOI: 10.1177/1062860613496135] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jason Ryan
- University of Connecticut Health Center, Farmington, CT
| | | | | | - Sangwook Kang
- University of Connecticut Health Center, Farmington, CT
- University of Connecticut, Storrs, CT
| | | | - Priti Mehla
- University of Connecticut Health Center, Farmington, CT
| | - Raj Ganeshan
- University of Connecticut Health Center, Farmington, CT
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Moura CSD, Tavares LS, Acurcio FDA. [Hospital readmissions related to drug interactions: a retrospective study in a hospital setting]. Rev Saude Publica 2013; 46:1082-9. [PMID: 23358622 DOI: 10.1590/s0034-89102013005000001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 06/28/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To examine the relationship between potential drug interactions and hospital readmissions. METHODS Retrospective study with 1,487 adult patients (> 18 years old) admitted to a general hospital in the city of Vitória da Conquista, Northeastern Brazil, from January to December 2007. Data were collected from Hospital Admission Authorization (AIH) forms in the Brazilian National Health System Hospital Database (SIH/SUS). Probabilistic linkage was used to combine multiple AIH forms from the same admission into a single record and to identify readmissions. Information on prescriptions was manually added to the SIH/SUS records. Logistic regression was used to quantitatively assess the impact of drug interactions on hospital readmissions. Cox regression was performed to test the impact of this variable on time to first readmission. RESULTS A total of 99 readmissions (7% of all patients) were identified. Potential drug interactions were found in 35% of all prescriptions evaluated. Patients with potential drug interactions in a prior admission were more likely to be readmitted. The adjusted odds ratio indicated a 2.4-fold increase in odds of being readmitted; and the adjusted hazard ratio showed that this risk was increased by 79% in patients with potential drug interactions (p < 0.01). CONCLUSIONS The study results suggest an association between prior drug interactions and increased risk of readmission. Health professionals should be aware of potential hazard of certain drug combinations and closely monitor high-risk patients such as elderly patients and those with renal impairment.
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Affiliation(s)
- Cristiano Soares de Moura
- Núcleo de Epidemiologia e Saúde Coletiva, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, BA, Brasil.
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Abstract
PURPOSE/OBJECTIVES This article examines the recent hospital emphasis on preventing hospital readmission. This article also identifies hospital programs that help prevent such readmissions by using a systematic approach to transitions of care. PRIMARY PRACTICE SETTING(S) Hospital case management departments. FINDINGS/CONCLUSIONS A coordinated, patient-focused transition of care plan is a key element in preventing hospital readmissions. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Leaders in hospital case management will have new demands placed on them to prevent patients from returning to the hospital after discharge. Leaders may choose to model demonstration programs, or they may implement unique strategies that support readmission prevention efforts.
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Sarangarm P, London MS, Snowden SS, Dilworth TJ, Koselke LR, Sanchez CO, D'Angio R, Ray G. Impact of pharmacist discharge medication therapy counseling and disease state education: Pharmacist Assisting at Routine Medical Discharge (project PhARMD). Am J Med Qual 2012; 28:292-300. [PMID: 23033542 DOI: 10.1177/1062860612461169] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many patients experience adverse events after discharge; numerous are medication related and preventable. The objective of this study is to evaluate the impact of pharmacist medication counseling and disease education at discharge. Pharmacist Assisting at Routine Medical Discharge is a prospective study of English- or Spanish-speaking adults discharged from internal medicine. Control patients received usual hospital discharge care; intervention patients received usual care with discharge counseling and a follow-up phone call. Evaluated outcomes included the following: 30-day hospital reutilization (combined readmissions/emergency department visits), pharmacist interventions, predictors for hospital utilization, patient satisfaction, and primary medication adherence. In all, 279 patients were enrolled: 139 in the control and 140 in the intervention group. Pharmacists made 198 interventions. The rate of hospital reutilization was 20.7% and similar between the intervention and control groups. Patients receiving the pharmacist intervention demonstrated improved primary medication adherence and increased patient satisfaction. Pharmacist-provided discharge counseling resulted in medication interventions, improved patient satisfaction, and increased medication adherence.
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Affiliation(s)
- Preeyaporn Sarangarm
- University of New Mexico Hospital, Pharmacy Administration, 2211 Lomas Blvd NE, Albuquerque, NM 87106, USA.
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Vyas A, Pan X, Sambamoorthi U. Chronic Condition Clusters and Polypharmacy among Adults. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2012; 2012:193168. [PMID: 22900173 PMCID: PMC3415173 DOI: 10.1155/2012/193168] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 06/19/2012] [Indexed: 05/23/2023]
Abstract
Objective. The primary objective of the study was to estimate the rates of polypharmacy among individuals with multimorbidity defined as chronic condition clusters and examine their associations with polypharmacy. Methods. Cross-sectional analysis of 10,528 individuals of age above 21, with at least one physical condition in cardiometabolic (diabetes or heart disease or hypertension), musculoskeletal (arthritis or osteoporosis), and respiratory (chronic obstructive pulmonary disease (COPD) or asthma) clusters from the 2009 Medical Expenditure Panel Survey. Chi-square tests and logistic regressions were performed to analyze the association between polypharmacy and multimorbidity. Results. Polypharmacy rates varied from a low of 7.2% among those with respiratory cluster to a high of 64.1% among those with all three disease clusters. Among those with two or more disease clusters, the rates varied from 28.3% for musculoskeletal and respiratory clusters to 41.8% for those with cardiometabolic and respiratory clusters. Individual with cardiometabolic conditions alone or in combination with other disease clusters were more likely to have polypharmacy. Compared to those with musculoskeletal and respiratory conditions, those with cardiometabolic and respiratory conditions had 1.68 times higher likelihood of polypharmacy. Conclusions. Rates of polypharmacy differed by specific disease clusters. Individuals with cardiometabolic condition were particularly at high risk of polypharmacy, suggesting greater surveillance for adverse drug interaction in this group.
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Affiliation(s)
- Ami Vyas
- Department of Pharmaceuticals Systems and Policy, Robert C. Byrd Health Sciences Center (North), West Virginia University, P.O. Box 9510, Morgantown, WV 26506-9510, USA
| | - Xiaoyun Pan
- Department of Pharmaceuticals Systems and Policy, Robert C. Byrd Health Sciences Center (North), West Virginia University, P.O. Box 9510, Morgantown, WV 26506-9510, USA
| | - Usha Sambamoorthi
- Department of Pharmaceuticals Systems and Policy, Robert C. Byrd Health Sciences Center (North), West Virginia University, P.O. Box 9510, Morgantown, WV 26506-9510, USA
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA 30310-1495, USA
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Pérez Pérez A, Gómez Huelgas R, Alvarez Guisasola F, García Alegría J, Mediavilla Bravo JJ, Menéndez Torre E. [Consensus document on the management after hospital discharge of patient with hyperglycaemia]. Med Clin (Barc) 2012; 138:666.e1-666.e10. [PMID: 22503128 DOI: 10.1016/j.medcli.2012.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 02/13/2012] [Accepted: 02/16/2012] [Indexed: 02/03/2023]
Abstract
The present document intends to adapt the general recommendations set up in a consensus to elaborate the hospital discharge report in medical specialties to the specific needs of the hospitalized diabetic population. Diabetes is an illness with a very high health cost, being the global risk of death in people with diabetes almost double than in non-diabetes people, justifying the fact that diabetes constitutes one of the most frequent diagnoses in hospitalized patients and the growing interest upon hyperglycaemia management during hospitalization and at discharge. To set up an adequate treatment plan at discharge suitable for each patient, the most important elements to take into account are the etiology and prior hyperglycaemia treatment, the patient's clinical situation and the degree of glycaemia control. Due to instability of glycaemia control, it is also needed to anticipate the educational needs for each patient, as well as to set up the monitoring schedule and follow-up at discharge, and an adequate treatment plan at discharge.
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Hakkarainen KM, Hedna K, Petzold M, Hägg S. Percentage of patients with preventable adverse drug reactions and preventability of adverse drug reactions--a meta-analysis. PLoS One 2012; 7:e33236. [PMID: 22438900 PMCID: PMC3305295 DOI: 10.1371/journal.pone.0033236] [Citation(s) in RCA: 182] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 02/03/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Numerous observational studies suggest that preventable adverse drug reactions are a significant burden in healthcare, but no meta-analysis using a standardised definition for adverse drug reactions exists. The aim of the study was to estimate the percentage of patients with preventable adverse drug reactions and the preventability of adverse drug reactions in adult outpatients and inpatients. METHODS Studies were identified through searching Cochrane, CINAHL, EMBASE, IPA, Medline, PsycINFO and Web of Science in September 2010, and by hand searching the reference lists of identified papers. Original peer-reviewed research articles in English that defined adverse drug reactions according to WHO's or similar definition and assessed preventability were included. Disease or treatment specific studies were excluded. Meta-analysis on the percentage of patients with preventable adverse drug reactions and the preventability of adverse drug reactions was conducted. RESULTS Data were analysed from 16 original studies on outpatients with 48797 emergency visits or hospital admissions and from 8 studies involving 24128 inpatients. No studies in primary care were identified. Among adult outpatients, 2.0% (95% confidence interval (CI): 1.2-3.2%) had preventable adverse drug reactions and 52% (95% CI: 42-62%) of adverse drug reactions were preventable. Among inpatients, 1.6% (95% CI: 0.1-51%) had preventable adverse drug reactions and 45% (95% CI: 33-58%) of adverse drug reactions were preventable. CONCLUSIONS This meta-analysis corroborates that preventable adverse drug reactions are a significant burden to healthcare among adult outpatients. Among both outpatients and inpatients, approximately half of adverse drug reactions are preventable, demonstrating that further evidence on prevention strategies is required. The percentage of patients with preventable adverse drug reactions among inpatients and in primary care is largely unknown and should be investigated in future research.
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Hakkarainen KM, Andersson Sundell K, Petzold M, Hägg S. Methods for Assessing the Preventability of Adverse Drug Events. Drug Saf 2012; 35:105-26. [DOI: 10.2165/11596570-000000000-00000] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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van Walraven C, Bennett C, Jennings A, Austin PC, Forster AJ. Proportion of hospital readmissions deemed avoidable: a systematic review. CMAJ 2011; 183:E391-402. [PMID: 21444623 DOI: 10.1503/cmaj.101860] [Citation(s) in RCA: 499] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Readmissions to hospital are increasingly being used as an indicator of quality of care. However, this approach is valid only when we know what proportion of readmissions are avoidable. We conducted a systematic review of studies that measured the proportion of readmissions deemed avoidable. We examined how such readmissions were measured and estimated their prevalence. METHODS We searched the MEDLINE and EMBASE databases to identify all studies published from 1966 to July 2010 that reviewed hospital readmissions and that specified how many were classified as avoidable. RESULTS Our search strategy identified 34 studies. Three of the studies used combinations of administrative diagnostic codes to determine whether readmissions were avoidable. Criteria used in the remaining studies were subjective. Most of the studies were conducted at single teaching hospitals, did not consider information from the community or treating physicians, and used only one reviewer to decide whether readmissions were avoidable. The median proportion of readmissions deemed avoidable was 27.1% but varied from 5% to 79%. Three study-level factors (teaching status of hospital, whether all diagnoses or only some were considered, and length of follow-up) were significantly associated with the proportion of admissions deemed to be avoidable and explained some, but not all, of the heterogeneity between the studies. INTERPRETATION All but three of the studies used subjective criteria to determine whether readmissions were avoidable. Study methods had notable deficits and varied extensively, as did the proportion of readmissions deemed avoidable. The true proportion of hospital readmissions that are potentially avoidable remains unclear.
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Gabe ME, Davies GA, Murphy F, Davies M, Johnstone L, Jordan S. Adverse drug reactions: treatment burdens and nurse-led medication monitoring. J Nurs Manag 2011; 19:377-92. [PMID: 21507109 DOI: 10.1111/j.1365-2834.2011.01204.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marie E Gabe
- Research Capacity Building Collaboration (RCBC) Wales, College of Human and Health Sciences, Swansea University, Swansea, UK.
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Delgoda R, Younger N, Barrett C, Braithwaite J, Davis D. The prevalence of herbs use in conjunction with conventional medicines in Jamaica. Complement Ther Med 2010; 18:13-20. [PMID: 20178874 DOI: 10.1016/j.ctim.2010.01.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 11/20/2009] [Accepted: 01/09/2010] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED Due to the global rise in the popularity of herbal medicines, adversities resulting from concomitant use of both prescription drugs and herbs are becoming an increasingly important public health issue. OBJECTIVES To estimate the prevalence of the use of herbal medicines among persons on prescription medicines in Jamaica. Findings are thought to aid in estimates of the risk of adversities from drug-herb interactions through laboratory investigations and to provide awareness among policy makers responsible for the design of appropriate pharmacovigilance systems in the country. METHODS A survey was conducted in eighteen pharmacies throughout Jamaica and patients or parents/carers of children who were on at least one prescription medicine were administered a structured questionnaire by trained interviewers. RESULTS Of 399 persons invited to participate in the study 365 (91.5% response rate) agreed to do so and were included in the study. This study population consisted of 306 adults and 60 children and of that 243 adults (80.6%) and 45 children (75.6%) engaged in the concomitant use of herbs and drugs. Patients with a variety of disease conditions, in both rural and urban environs engaged in concomitant herb-drug use. Persons with higher salary (P<0.1) and those with health insurance (P<0.02) tended to have a lower prevalence of herb-drug concomitant use. Among persons indicating such practices the most commonly cited reason for concurrent use of prescription medicine and herbal preparations was the belief that there was no harm in taking both (269, 94.0%) followed by the belief that the prescription medicine alone was not adequate cure (211, 71%). Only 55 (18%) respondents who practised such co-medication indicated that their doctors knew of their use of herbal preparations. CONCLUSION There is a high prevalence of herb-drug concomitant use in Jamaica, and an awareness within the medical community and those monitoring adversities would serve well to mitigate risks from potential drug-herb interactions.
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Affiliation(s)
- Rupika Delgoda
- Natural Products Institute, University of the West Indies, Mona, Jamaica.
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