Discharge medication complexity and 30-day heart failure readmissions

Colavecchia, A. Carmine; Putney, David; Johnson, Michael L.; Aparasu, Rajender R.

doi:10.1016/j.sapharm.2016.10.002

Cited by 27 publications

(44 citation statements)

References 27 publications

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“…Overall, the present MRCIs are comparable with those reported for patients with other chronic diseases such as diabetes mellitus, heart failure and chronic obstructive pulmonary disease . The MRCIs for the present HD patients were lower than those in two previous studies involving HD patients who were considerably younger, having mean ages of 68 years and 54 years .…”

Section: Discussionsupporting

confidence: 53%

Medication regimen complexity and medication adherence in elderly patients with chronic kidney disease

Parker

Bull-Engelstad

Aasebø

et al. 2019

Hemodialysis International

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Introduction: Elderly patients with chronic kidney disease (CKD) stage 5 with or without dialysis treatment usually have concomitant comorbidities, which often result in multiple pharmacological therapies. This study aimed to identify factors associated with medication complexity and medication adherence, as well as the association between medication complexity and medication adherence, in elderly patients with CKD. Methods: This prospective study involved elderly patients with CKD stage 5 (estimated glomerular filtration rate < 15 ml/min/1.73m2) recruited from three Norwegian hospitals. Most of the patients were receiving either hemodialysis or peritoneal dialysis. We used the Medication Regimen Complexity Index (MRCI) to assess the complexity of medication regimens, and the eight‐item Morisky Medication Adherence Scale (MMAS‐8) to assess medication adherence. Factors associated with the MRCI and MMAS‐8 score were determined using either multivariable linear or ordinal logistic regression analysis. Findings: In total, 157 patients aged 76 ± 7.2 years (mean ± SD) were included in the analysis. Their overall MRCI score was 22.8 ± 7.7. In multivariable linear regression analyses, female sex (P = 0.044), Charlson Comorbidity Index of 4 or 5 (P = 0.029) and using several categories of phosphate binders (P < 0.001 to 0.04) were associated with the MRCI. Moderate or high adherence (MMAS‐8 score ≥ 6) was demonstrated by 83% of the patients. The multivariable logistic regression analyses found no association of medication complexity, age or other variables with medication adherence as assessed using the MMAS‐8. Discussion: Female sex, comorbidity and use of phosphate binders were associated with more‐complex medication regimens in this population. No association was found between medication regimen complexity, phosphate binders or age and medication adherence. These findings are based on a homogeneous elderly group, and so future studies should test if they can be generalized to patients of all ages with CKD.

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Section: Discussionsupporting

confidence: 53%

Medication regimen complexity and medication adherence in elderly patients with chronic kidney disease

Parker

Bull-Engelstad

Aasebø

et al. 2019

Hemodialysis International

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“…From a public health perspective, this finding is of considerable importance, as the probability of an adverse drug reaction increases to 82% when seven or more medications are prescribed 46. To date, most assessments of medication regimen complexity in heart failure patients have been conducted in the hospital setting 36,38,39. For example, Yam et al reported a mean pMRCI score and medication count of 35.5±19 and 12.9±6.3, respectively, at the time of hospital admission in a predominantly male (97%) cohort of US veterans with heart failure.…”

Section: Discussionmentioning

confidence: 99%

Medication regimen complexity in ambulatory older adults with heart failure

Cobretti¹,

Page

Linnebur

et al. 2017

CIA

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PurposeHeart failure prevalence is increasing in older adults, and polypharmacy is a major problem in this population. We compared medication regimen complexity using the validated patient-level Medication Regimen Complexity Index (pMRCI) tool in “young-old” (60–74 years) versus “old-old” (75–89 years) patients with heart failure. We also compared pMRCI between patients with ischemic cardiomyopathy (ISCM) versus nonischemic cardiomyopathy (NISCM).Patients and methodsMedication lists were retrospectively abstracted from the electronic medical records of ambulatory patients aged 60–89 years with heart failure. Medications were categorized into three types – heart failure prescription medications, other prescription medications, and over-the-counter (OTC) medications – and scored using the pMRCI tool.ResultsThe study evaluated 145 patients (n=80 young-old, n=65 old-old, n=85 ISCM, n=60 NISCM, mean age 73±7 years, 64% men, 81% Caucasian). Mean total pMRCI scores (32.1±14.4, range 3–84) and total medication counts (13.3±4.8, range 2–30) were high for the entire cohort, of which 72% of patients were taking eleven or more total medications. Total and subtype pMRCI scores and medication counts did not differ significantly between the young-old and old-old groups, with the exception of OTC medication pMRCI score (6.2±4 young-old versus 7.8±5.8 old-old, P=0.04). With regard to heart failure etiology, total pMRCI scores and medication counts were significantly higher in patients with ISCM versus NISCM (pMRCI score 34.5±15.2 versus 28.8±12.7, P=0.009; medication count 14.1±4.9 versus 12.2±4.5, P=0.008), which was largely driven by other prescription medications.ConclusionMedication regimen complexity is high in older adults with heart failure, and differs based on heart failure etiology. Additional work is needed to address polypharmacy and to determine if medication regimen complexity influences adherence and clinical outcomes in this population.

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“…25 Finally, the number of drugs prescribed was registered. 24 TA B L E 1 Demographic data of the study population, source of admission, and comorbid conditions of study patients…”

Section: Gfimentioning

confidence: 99%

“…Mean LOS was 12 [8][9][10][11][12][13][14][15][16][17][18][19][20] days: LOS was significantly shorter in HDU patients (9 [6][7][8][9][10][11][12][13][14][15][16] in HDU, 15 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] in Ger, 12 [8][9][10][11][12][13][14][15][16]…”

Section: Follow-up and Outcomesmentioning

confidence: 99%

“…Different clinical aspects were described in previous studies as good predictors of readmission. Adverse drug reactions are the main cause of up to a fourth of hospital admissions and are ranked as the fourth to sixth leading cause of death in the USA; thus, the use of more than five medications by itself was shown to correlate with readmission.…”

Section: Introductionmentioning

confidence: 99%

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Inpatient disposition in overcrowded hospitals: is it safe and effective to use reverse triage and readmission screening tools for appropriate discharge? An observational prospective study of an Italian II level hospital

et al. 2018

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Summary Background Reverse triage (RT) identifies patients eligible for discharge and have been proposed to cope with daily surge. Nevertheless, early discharge could increase the rate of readmission. Our aim is to test the effectiveness and safety of RT alone and with readmission screening tools (Identification Senior At Risk [ISAR], HOSPITAL, and Groeningen Frailty Index [GFI] scores) to predict appropriate discharge. Material and methods We prospectively assessed every 4 days (t0) inpatients of medical divisions (High Dependency Unit (HDU), Internal Medicine (IM), and Geriatrics (Ger)) of an Italian Hospital. RT score was calculated for each patient and an RT ≤3 identified those eligible for safe discharge. ISAR, HOSPITAL, and GFI were then applied. We assessed reinstituting of interventions and transferring to an increased level of care unit at 4 days as an ethical proxy of consequential medical events following hypothetical discharge. Date of effective discharge, death, and readmission were measured at 4, 7, 15, and 30 days after the first evaluation. Results Twenty‐five (9.6%) out of 260 patients in our sample had an RT ≤3. Twenty‐four (96%) of them compared with 205 (87%) of the RT >3 group (P = NS) were discharged. Patients with RT ≤3 were discharged significantly earlier (3.5 vs 8 days after t0 [P = 0.0002]). In the RT ≤3 group, all but one patient were alive and healthy at 7, 15, and 30 days. The HOSPITAL score seemed to have the best concordance with RT (84%), in comparison with the ISAR (52%) and the GFI (48%) scores. RT showed a low sensitivity (22%) and high specificity (95%), which was even higher when using RT associated with readmission screening tools. Conclusions Reverse triage proved to be a safe and conservative tool, with high specificity alone and with readmission screening tools. RT correctly identifies patients that will be discharged earlier.

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Discharge medication complexity and 30-day heart failure readmissions

Cited by 27 publications

References 27 publications

Medication regimen complexity and medication adherence in elderly patients with chronic kidney disease

Medication regimen complexity and medication adherence in elderly patients with chronic kidney disease

Medication regimen complexity in ambulatory older adults with heart failure

Inpatient disposition in overcrowded hospitals: is it safe and effective to use reverse triage and readmission screening tools for appropriate discharge? An observational prospective study of an Italian II level hospital

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