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

Aims Polypharmacy 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...

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Veröffentlicht in:British journal of clinical pharmacology Jg. 84; H. 8; S. 1789 - 1797
Hauptverfasser: Parekh, Nikesh, Ali, Khalid, Stevenson, Jennifer M., Davies, J. Graham, Schiff, Rebekah, Van der Cammen, Tischa, Harchowal, Jatinder, Raftery, James, Rajkumar, Chakravarthi
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England John Wiley and Sons Inc 01.08.2018
Schlagworte:
Aftercare - statistics & numerical data
Aged
Aged, 80 and over
Drug-Related Side Effects and Adverse Reactions - economics
Drug-Related Side Effects and Adverse Reactions - epidemiology
Drug-Related Side Effects and Adverse Reactions - therapy
Female
Health Care Costs - statistics & numerical data
health economics
health service use
hospital discharge
Hospitals, Teaching - economics
Hospitals, Teaching - statistics & numerical data
Humans
Inappropriate Prescribing - adverse effects
Inappropriate Prescribing - economics
Inappropriate Prescribing - prevention & control
Inappropriate Prescribing - statistics & numerical data
Incidence
Male
medication harm
older adults
Original
Patient Discharge
Patient Discharge Summaries - statistics & numerical data
Patient Readmission - economics
Patient Readmission - statistics & numerical data
pharmacoepidemiology
Pharmacy Service, Hospital - economics
Pharmacy Service, Hospital - organization & administration
Pharmacy Service, Hospital - statistics & numerical data
Polypharmacy
Prospective Studies
State Medicine - economics
State Medicine - statistics & numerical data
United Kingdom - epidemiology
United Kingdom
older adults
medication harm
health service use
hospital discharge
health economics
pharmacoepidemiology
ISSN:0306-5251, 1365-2125, 1365-2125
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Zusammenfassung:Aims Polypharmacy 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. Methods An 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. Results Overall, 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. Conclusions MRH is common in older adults following hospital discharge, and results in substantial use of healthcare resources.
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The PRIME study group: Coordinating team: K. Ali (co‐lead investigator), C. Rajkumar (co‐lead investigator), J. G. Davies (chief trial pharmacist), J. Harchowal (trial pharmacist), J. Timeyin (trial coordinator); Steering committee: K. Ali, C. Rajkumar, J. G. Davies, R. Schiff, J. M. Stevenson, T. van der Cammen; Data monitoring committee: K. Ali, C. Rajkumar, J. Timeyin, L. Klus, D. Fatz; End points committee: K. Ali, C. Rajkumar, J. G. Davies, R. Schiff; Lead investigators: K. Ali (Princess Royal Hospital, Haywards Heath, Brighton and Sussex University Hospitals NHS Trust), C. Rajkumar (Royal Sussex County Hospital, Brighton, Brighton and Sussex University Hospitals NHS Trust), R.Schiff (St Thomas' Hospital, London), A.Chauhan (Queen Alexandra Hospital, Portsmouth), D.Hunt (Worthing Hospital, Worthing); Trial pharmacists: J. M. Stevenson, K. Le Bosquet, St Thomas' Hospital; J. Allen, N. Henderson, Brighton and Sussex University Hospitals NHS Trust, C. Gonzalaz‐Cuevas, S. Burke‐Adams, Worthing Hospital; N. Khan, K. Yip, Queen Alexandra Hospital; Trial nurses: J. Timeyin, J. Breeds, J. Gaylard, J. Newman, Brighton and Sussex University Hospitals NHS Trust; T. Pettifer, St Thomas' Hospital; H. Fox, M. G. Metiu, Worthing Hospital; D. Foord, S. Valentine, T. Dobson, Queen Alexandra Hospital.
ISSN:0306-5251
1365-2125
1365-2125
DOI:10.1111/bcp.13613