Impact of in-hospital medication changes on clinical outcomes in older inpatients: the journey and destination.
Background Medication review is integral in the pharmacological management of older inpatients. Objective To assess the association of in-hospital medication changes with 28-day postdischarge clinical outcomes. Methods Retrospective cohort of 2000 inpatients aged ≥75 years. Medication changes includ...
| Publicado en: | Age & Ageing Vol. 54; no. 2; pp. 1 - 11 |
|---|---|
| Autores principales: | , , , , , , , |
| Formato: | Artículo |
| Publicado: |
Oxford University Press / USA
Feb2025
|
| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=183369961&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 183369961 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Feb2025 vid: 54 iid: 2 pid: 622 pub: Oxford University Press / USA artinfo: ui: 183369961 10.1093/ageing/afae282 ppf: 1 ppct: 10 formats: tig: atl: Impact of in-hospital medication changes on clinical outcomes in older inpatients: the journey and destination. aug: au: Masnoon, Nashwa Lo, Sarita Gnjidic, Danijela McLachlan, Andrew J Blyth, Fiona M Burke, Rosemary Capuano, Ana W Hilmer, Sarah N affil: Kolling Institute, Faculty of Medicine and Health, The University of Sydney and Northern Sydney Local Health District, Sydney, New South Wales, Australia Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia Department of Pharmacy, Sydney Local Health District, Sydney, New South Wales, Australia Rush Alzheimer's Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, New South Wales, Australia su: Evaluation of medical care Patient care Retrospective studies Drugs Patient readmissions Logistic regression analysis Hospital patients Medication error prevention Medication reconciliation Hospital emergency services Polypharmacy Deprescribing Odds ratio Confidence intervals sug: subj: Evaluation of medical care Patient care Retrospective studies Drugs Pharmaceutical and medicine manufacturing Pharmaceuticals and pharmacy supplies merchant wholesalers Drugs and Druggists' Sundries Merchant Wholesalers Patient readmissions Logistic regression analysis Hospital patients Medication error prevention Medication reconciliation Hospital emergency services Polypharmacy Deprescribing Odds ratio Confidence intervals keyword: beers criteria clinical outcomes deprescribing diagnosis gender geriatrics inpatients medication review mortality older adult older people patient readmission polypharmacy potentially inappropriate medication list sensitivity analysis terminally ill treatment outcome beers criteria clinical outcomes deprescribing diagnosis gender geriatrics inpatients medication review mortality older adult older people patient readmission polypharmacy potentially inappropriate medication list sensitivity analysis terminally ill treatment outcome ab: Background Medication review is integral in the pharmacological management of older inpatients. Objective To assess the association of in-hospital medication changes with 28-day postdischarge clinical outcomes. Methods Retrospective cohort of 2000 inpatients aged ≥75 years. Medication changes included the number of increases (medications started or dose-increased) and decreases (medications stopped or dose-decreased) for (i) all medications, (ii) Drug Burden Index (DBI)–contributing medications and (iii) Beers Criteria 2015 medications (potentially inappropriate medications, PIMs). Changes also included differences in (i) the number of medications, (ii) the number of PIMs and (iii) DBI score, at discharge versus admission. Associations with clinical outcomes (28-day ED visit, readmission and mortality) were ascertained using logistic regression, adjusted for age, gender and principal diagnosis. For mortality, sensitivity analysis excluded end-of-life patients due to higher death risk. Patients were stratified into : (i) ≤4, (ii) 5–9 and (iii) ≥10 discharge medications. Results The mean age was 86 years (SD = 5.8), with 59.1% female. Medication changes reduced ED visits and readmission risk for patients prescribed five to nine discharge medications, with no associations in patients prescribed ≤4 and ≥ 10 medications. In the five to nine medications group, decreasing PIMs reduced risks of ED visit (adjusted odds ratio, aOR 0.55, 95% CI 0.34–0.91, P = .02) and readmission (aOR 0.62, 95% CI 0.38–0.99, P = .04). Decreasing DBI-contributing medications reduced readmission risk (aOR 0.71, 95% CI 0.51–0.99, P = .04). Differences in PIMs reduced ED visit risk (aOR 0.65, 95% CI 0.43–0.99, P = .04). There were no associations with mortality in sensitivity analyses in all groups. Discussion Medication changes were associated with reduced ED visits and readmission for patients prescribed five to nine discharge medications. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
|---|