[Hospital readmissions related to drug interactions: a retrospective study in a hospital setting]

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.

Evidence-based risk factors for adverse health outcomes in older patients after discharge home and assessment tools: a systematic review

The current health care system is discharging elderly patients "quicker" and "sicker" from acute care facilities. Consequently, hospital readmission is common; however, readmission may be only one aspect of adverse outcomes of importance to social work discharge planners. The early recognition of risk factors might ensure a successful transition from the hospital to the home. A systematic review was conducted to identify factors associated with adverse outcomes in older patients discharged from hospital to home. Using a content analysis, factors were characterized in five domains: demographic factors, patient characteristics, medical and biological factors, social factors, and discharge factors. The most frequently reported risks were depression, poor cognition, comorbidities, length of hospital stay, prior hospital admission, functional status, patient age, multiple medications, and lack of social support. A systematic search identified four discharge assessment tools for use with the general population of elderly patients. Practice and research implications are offered.

Study on drug related hospital admissions in a tertiary care hospital in South India

BACKGROUND AND OBJECTIVES

Accidental and intentional poisonings or drug overdoses constitute a significant source of aggregate morbidity, mortality, and health care expenditure. Studies evaluating drug related hospitalization have estimated that approximately 5-10% of all hospital admissions are drug related. The present study was carried out to investigate type, nature and incidence of drug related admissions in our hospital settings.

METHOD

A hospital based retrospective study was conducted in 575 cases of drug related admissions. The case records of patients admitted in various clinical departments of Amrita Institute of Medical Sciences (AIMS) Hospital during last 8 years (January 2002-December 2009) were collected and analyzed.

RESULTS

During the retrospective study, the total number of drug related cases reported were 575. Out of these, 35.5% cases were induced by central nervous system (CNS) drugs, 19.8% were by cardiovascular system (CVS) drugs, 12.3% were by NSAIDs, 11.3% were by antibiotics and 9.9% were by anticoagulants, 11.3% by other drugs which includes hormones, cytotoxic drugs, hypolipidemics, etc. Four hundred and forty cases were admitted to emergency department. Common drug related problems resulting in hospital visits were due to intentional, accidental and overdose. The incidence of drug related hospital admissions was found to be 0.20%.

CONCLUSION

The most of the accidental and suicidal cases were reported are by CNS drugs. Psychiatric patients intentionally taking medicines as suicidal attempt and as a part of their illness. As drug related problems are so significant, increased awareness and enhanced collaborative efforts among patients, physicians, pharmacists and caregivers within community and hospital have the potential to minimize the impact of this problem.