Longitudinal Association of a Medication Risk Score With Mortality Among Ambulatory Patients Acquired Through Electronic Health Record Data

Ratigan, Amanda R.; Michaud, Véronique; Turgeon, Jacques; Bikmetov, Ravil; Villarreal, Gabriela Gaona; Anderson, Heather; Pulver, Gerald; Pace, Wilson D.

doi:10.1097/pts.0000000000000829

Cited by 19 publications

(13 citation statements)

References 34 publications

(64 reference statements)

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“…This study found a one-point increase in the score correlates with an 8.6% odds increase of one or more ADEs per year, $1000 in annual medical spending, and 2.1 additional hospitalizations per year [17]. This score was also demonstrated to be associated with an increased risk of premature death in more than 400,000 patients followed for 7 years [16]. In addition to a medication risk score, the tool provides clinical decision support and consequently provides actionable ways to reduce medication risk.…”

Section: Introductionmentioning

confidence: 68%

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Classification and Assessment of Medication Risk in the Elderly (CARE): Use of a Medication Risk Score to Inform Patients’ Readmission Likelihood after Hospital Discharge

Filippo

Michaud²,

Wei

et al. 2021

JCM

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Existing risk tools that identify patients at high risk of medication-related iatrogenesis are not sufficient to holistically evaluate a patient’s entire medication regimen. This study used a novel medication risk score (MRS) which holistically evaluates medication regimens and provides actionable solutions. The main purpose of this study was to quantify adults ≥ 65 years with a high medication risk burden using the MRS and secondarily, appraise MRS association with hospital readmission. This retrospective cohort study included all consecutive patients in a 6-month period aged 65 years and older, admitted for at least 48 h, and prescribed at least five medications upon discharge. Out of 3017 patients screened, 1386 met all criteria. The primary outcome was the proportion of patients with a score of ≥ 20 and the secondary outcome was the 30-day readmission rate. In the overall population, 17% of patients had an MRS ≥ 20. For patients discharged home, there was a 19% readmission rate for a score ≥ 20 and 11% for <20 (p = 0.009). A score of ≥ 20 was associated with a 1.8-fold increased risk of readmission in patients discharged home. Only 7% of patients met these criteria, which can help direct future use of the MRS at patients with the highest risk of medication-related iatrogenesis.

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Section: Introductionmentioning

confidence: 68%

“…The resulting score ranges from 0-53; a score of less than 10, 10-14, 15-19, 20-30, and greater than 30 is interpreted as minimal, low, intermediate, high, and severe risk, respectively [16]. The tool was validated in a cohort of 1965 patients of the Programs of All-Inclusive Care for the Elderly.…”

Section: Introductionmentioning

confidence: 99%

Classification and Assessment of Medication Risk in the Elderly (CARE): Use of a Medication Risk Score to Inform Patients’ Readmission Likelihood after Hospital Discharge

Filippo

Michaud²,

Wei

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

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“…Bankes et al reported that each point increase in the MRS was associated with an 8.6% higher risk of having one or more ADEs per year, over USD 1000 in additional medical spending a year, 3.2 additional emergency department visits per 100 patients annually, and 2.1 more hospitalizations per 100 patients per year [ 36 ]. Ratigan et al recently reported that although further evidence is needed to demonstrate that lowering the MRS results in a decrease in ADEs or death, interventions among patients on multiple medications that have higher MRS can enhance medication safety [ 54 ]. In this case, the decrease in the MRS was attributed to the fact that DDI-associated risk was diminished with the implementation of the clinical interventions.…”

Section: Discussionmentioning

confidence: 99%

Pharmacist-Led Medication Evaluation Considering Pharmacogenomics and Drug-Induced Phenoconversion in the Treatment of Multiple Comorbidities: A Case Report

Toro-Pagán¹,

Matos²,

Thacker

et al. 2021

Medicina

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Pharmacogenomic (PGx) information can guide drug and dose selection, optimize therapy outcomes, and/or decrease the risk of adverse drug events (ADEs). This report demonstrates the impact of a pharmacist-led medication evaluation, with PGx assisted by a clinical decision support system (CDSS), of a patient with multiple comorbidities. Following several sub-optimal pharmacotherapy attempts, PGx testing was recommended. The results were integrated into the CDSS, which supported the identification of clinically significant drug–drug, drug–gene, and drug–drug–gene interactions that led to the phenoconversion of cytochrome P450. The pharmacist evaluated PGx results, concomitant medications, and patient-specific factors to address medication-related problems. The results identified the patient as a CYP2D6 intermediate metabolizer (IM). Duloxetine-mediated competitive inhibition of CYP2D6 resulted in phenoconversion, whereby the patient’s CYP2D6 phenotype was converted from IM to poor metabolizer for CYP2D6 co-medication. The medication risk score suggested a high risk of ADEs. Recommendations that accounted for PGx and drug-induced phenoconversion were accepted. After 1.5 months, therapy changes led to improved pain control, depression status, and quality of life, as well as increased heart rate, evidenced by patient-reported improved sleep patterns, movement, and cognition. This case highlights the pharmacist’s role in using PGx testing and a CDSS to identify and mitigate medication-related problems to optimize medication regimen and medication safety.

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“…The MRS was significantly associated with an increase of ADEs, emergency visits and medical expenditures [28]. Recently, a longitudinal study including 427,103 patients showed that the MRS was also independently associated with premature death [29]. Overall, opioid users and CYP2D6 opioid users were associated with higher MRS, indicating that they are at increased risk for ADEs.…”

Section: Cyp2d6 Opioids With and Without Interacting Drugsmentioning

confidence: 99%

“…Drug claims data could represent a reliable source to attribute risk of adverse drug events (ADE) associated with medications in outpatient populations [27]. We recently reported the association of a proprietary medication risk score (MRS) based on drug claims with health outcomes including ADE, medical expenditures, hospitalizations, emergency department visits, hospital length of stay and death [28][29][30].…”

Section: Introductionmentioning

confidence: 99%

Use of Drug Claims Data and a Medication Risk Score to Assess the Impact of CYP2D6 Drug Interactions among Opioid Users on Healthcare Costs

Michaud

Bikmetov

Smith

et al. 2021

JPM

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Cytochrome P450 2D6 (CYP2D6) activity is highly variable due to several factors, including genetic polymorphisms and drug-drug-gene interactions. Hydrocodone, oxycodone, codeine, and tramadol the most commonly prescribed CYP2D6-activated opioids for pain. However, the co-administration of CYP2D6 interacting drugs can modulate CYP2D6-medicated activation of these opioids, affecting drug analgesia, effectiveness, and safety, and can impact healthcare costs. A retrospective, observational cohort analysis was performed in a large (n = 50,843) adult population. This study used drug claims data to derive medication risk scores and matching propensity scores to estimate the effects of opioid use and drug-drug interactions (DDIs) on medical expenditures. 4088 individuals were identified as opioid users; 95% of those were prescribed CYP2D6-activated opioids. Among those, 15% were identified as being at risk for DDIs. Opioid users had a significant increase in yearly medical expenditure compared to non-opioid users ($2457 vs. $1210). In matched individuals, average healthcare expenditures were higher for opioid users with DDIs compared to those without DDIs ($7841 vs. $5625). The derived medication risk score was higher in CYP2D6 opioid users with interacting drug(s) compared to no DDI (15 vs. 12). Higher costs associated with CYP2D6 opioid use under DDI conditions suggest inadequate CYP2D6 opioid prescribing practices. Efforts to improve chronic opioid use in adults should reduce interacting drug combinations, especially among patients using CYP2D6 activated opioids.

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Longitudinal Association of a Medication Risk Score With Mortality Among Ambulatory Patients Acquired Through Electronic Health Record Data

Abstract: Supplemental digital content is available in the text.

Cited by 19 publications

References 34 publications

Classification and Assessment of Medication Risk in the Elderly (CARE): Use of a Medication Risk Score to Inform Patients’ Readmission Likelihood after Hospital Discharge

Classification and Assessment of Medication Risk in the Elderly (CARE): Use of a Medication Risk Score to Inform Patients’ Readmission Likelihood after Hospital Discharge

Pharmacist-Led Medication Evaluation Considering Pharmacogenomics and Drug-Induced Phenoconversion in the Treatment of Multiple Comorbidities: A Case Report

Use of Drug Claims Data and a Medication Risk Score to Assess the Impact of CYP2D6 Drug Interactions among Opioid Users on Healthcare Costs

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