Incidence and cost of medication harm in older adults following hospital discharge

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

Parekh, Nikesh (Brighton and Sussex Medical School; Brighton and Sussex University Hospitals’ Trust)
Ali, Khalid (Brighton and Sussex Medical School; Brighton and Sussex University Hospitals’ Trust)
Stevenson, Jennifer M. (King’s College London)
Davies, J. Graham (King’s College London)
Schiff, Rebekah (Guy’s and St. Thomas’ NHS Foundation Trust)
van der Cammen, T.J.M. (TU Delft Applied Ergonomics and Design; Brighton and Sussex Medical School)
Harchowal, Jatinder (The Royal Marsden NHS Foundation Trust)
Raftery, James (University of Southampton)
Rajkumar, Chakravarthi (Brighton and Sussex Medical School; Brighton and Sussex University Hospitals’ Trust)

2018

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 this study was to investigate the incidence, severity, preventability and cost of medication-related harm (MRH) in older adults in England post-discharge.

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 eight weeks by senior pharmacists, using 3 data sources (hospital readmission review, participant telephone interview and primary care records), to identify MRH and associated health service utilisation.

RESULTS:

Four hundred and thirteen participants (37%) experienced MRH (556 MRH events per 1000 discharges). Three hundred and thirty-six (81%) cases were serious, and 214 (52%) potentially preventable. Four participants experienced fatal MRH. The most common MRH events were gastrointestinal (n=158, 25%) and neurological (n=111, 18%). Medicine classes associated with the highest risk of MRH were opiates, antibiotics, and benzodiazepines. Three hundred and twenty-eight (79%) participants with MRH sought healthcare over the eight-week follow-up. The incidence of MRH associated hospital readmission was 78 per 1000 discharges. Post-discharge 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.

Medication harm
health economics
health service use
hospital discharge
older adults
pharmacoepidemiology

http://resolver.tudelft.nl/uuid:1825ce39-d19e-402c-a9e0-891f9f16ad9d

https://doi.org/10.1111/bcp.13613

British Journal of Clinical Pharmacology, 84, 1789-1797

Institutional Repository

journal article

© 2018 Nikesh Parekh, Khalid Ali, Jennifer M. Stevenson, J. Graham Davies, Rebekah Schiff, T.J.M. van der Cammen, Jatinder Harchowal, James Raftery, Chakravarthi Rajkumar