Incidence and cost of medication harm in older adults following hospital discharge: a multicentre prospective study in the UK

Abstract

AimsPolypharmacy is increasingly common in older adults, placing them at risk of medication‐related harm (MRH). Patients are particularly vulnerable to problems with their medications in the period following hospital discharge due to medication changes and poor information transfer between hospital and primary care. The aim of the present study was to investigate the incidence, severity, preventability and cost of MRH in older adults in England postdischarge.MethodsAn observational, multicentre, prospective cohort study recruited 1280 older adults (median age 82 years) from five teaching hospitals in Southern England, UK. Participants were followed up for 8 weeks by senior pharmacists, using three data sources (hospital readmission review, participant telephone interview and primary care records), to identify MRH and associated health service utilization.ResultsOverall, 413 participants (37%) experienced MRH (556 MRH events per 1000 discharges), of which 336 (81%) cases were serious and 214 (52%) potentially preventable. Four participants experienced fatal MRH. The most common MRH events were gastrointestinal (n = 158, 25%) or neurological (n = 111, 18%). The medicine classes associated with the highest risk of MRH were opiates, antibiotics and benzodiazepines. A total of 328 (79%) participants with MRH sought healthcare over the 8‐week follow‐up. The incidence of MRH‐associated hospital readmission was 78 per 1000 discharges. Postdischarge MRH in older adults is estimated to cost the National Health Service £396 million annually, of which £243 million is potentially preventable.ConclusionsMRH is common in older adults following hospital discharge, and results in substantial use of healthcare resources.

Do the 2015 Beers Criteria predict medication‐related harm in older adults? Analysis from a multicentre prospective study in the United Kingdom

“…Four hundred and thirteen participants out of 1116 (37%) experienced MRH within 8‐weeks postdischarge . Antihypertensives (22.4%), opiates (17.2%), diuretics (12.2%), and antibiotics (10.5%) were implicated in the highest proportion of MRH events.…”

“…To investigate the relationship between Beers Criteria PIMs and adverse outcomes, we used data from the multicentre, prospective cohort PRIME study . Detailed methods are available in the published protocol .…”

“…To investigate the relationship between Beers Criteria PIMs and adverse outcomes, we used data from the multicentre, prospective cohort PRIME study. 5,12 Detailed methods are available in the published protocol. 12 Between 2013 and 2015, adults aged 65 years and over were recruited from medical wards in five hospitals in England just prior to hospital discharge.…”

“…In England, MRH is leading to an increasing number of hospital admissions . The direct health care costs of MRH in older adults following hospital discharge in England is conservatively estimated at £400 million annually, of which 90% of cost is attributable to hospital readmission …”

“…4 The direct health care costs of MRH in older adults following hospital discharge in England is conservatively estimated at £400 million annually, of which 90% of cost is attributable to hospital readmission. 5 Inappropriate prescribing is an avoidable risk factor for MRH in older adults and can be defined as medicines with a higher probability of causing harm than benefit to the individual. 6 Numerous explicit lists of medicines to avoid in older adults are available (eg, Beers, Screening Tool of Older People's Prescriptions (STOPP), European Union (7)-Potentially Inappropriate Medications (EU-PIM), and PRISCUS criteria).…”