Hospital readmission within 30 days of older adults hospitalized in a public hospital

Older adults have difficulty monitoring their drug therapy in the first thirty days following hospital discharge. This transition care period may trigger hospital readmissions. The study aims to identify the factors associated with the readmission of older adults 30 days after discharge from the perspective of drug therapy. This is a cross-sectional study and hospital admission within 30 days was defined as readmission to any hospital 30 days after discharge. The complexity of the drug therapy was established by the Medication Regimen Complexity Index (MRCI).. Readmission risks were predicted by the "Readmission Risk Score - RRS". The multivariate logistic regression was used to identify factors associated with readmission within 30 days after discharge. Two hundred fifty-five older adults were included in the study, of which 32 (12.5%) had non-elective hospital readmission. A higher number of readmissions was observed with increased RRS value, suggesting a linear gradient effect. The variables included in the final logistic regression model were the diagnosis of cancer (OR=2.9, p=0.031), pneumonia (OR=2.3, p=0.055), and High MRCI (> 16.5) following discharge (OR=1.9, p=0.119). The cancer diagnosis is positively associated with hospital readmissions of older adults within 30 days

Factors associated with the use of potentially inappropriate medication by elderly patients prescribed at hospital discharge / Fatores associados ao uso de medicamentos potencialmente inapropriados para idosos na alta hospitalar

ABSTRACT Objective To analyze the frequency of use of potentially inappropriate medication prescribed to elderly at hospital discharge from a public hospital, considering the Brazilian Consensus on Potentially Inappropriate Medication for Elderly, and to identify the associated factors. Methods Patients aged ≥60 years, admitted in clinical and geriatric units of a public hospital were invited to participate in the study. The information about the use of medicines was collected from the patient's electronic record and through telephone contact. The Brazilian Consensus on Potentially Inappropriate Medication for Elderly was used to classify the medication, regardless of the clinical condition. Results A total of 255 elders were included in this study. The frequency of use of potentially inappropriate medication by elderly was 58.4%. The potentially inappropriate medication use in elderly was positively associated with the presence of depression (odds ratio of 2.208) and polypharmacy (odds ratio of 2.495). The hospitalization in a geriatric unit showed an inverse association with the potentially inappropriate medication use in elderly (odds ratio of 0.513). Conclusion The frequency of potentially inappropriate medication prescription to elderly upon hospital discharge was high. The presence of depression and polypharmacy were directly associated with use of potentially inappropriate medication in the elderly. Admission to the geriatric clinic has become a protection factor for the use of potentially inappropriate medication in elderly. Strategies to improve the elderly pharmacotherapy should implemented aiming at healthcare quality and safety in the transition of care.

RESUMO Objetivo Analisar a frequência de uso de medicamentos potencialmente inapropriados para idosos na prescrição de alta hospitalar de idosos de um hospital público, considerando o Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos, e identificar os fatores associados. Métodos Pacientes com idade ≥60 anos, internados nas unidades de clínica médica e geriátrica de um hospital público, foram convidados para participar do estudo. As informações sobre o uso de medicamentos foram coletadas do prontuário eletrônico do paciente e confirmadas por contato telefônico. O Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos independente da condição clínica foi utilizado para a classificação dos medicamentos. Resultados Foram incluídos no estudo 255 idosos. A frequência de uso de medicamentos potencialmente inapropriados para idosos foi de 58,4%. O uso de medicamentos potencialmente inapropriados para idosos foi associado positivamente à presença de depressão (razão de chance de 2,208) e polifarmácia (razão de chance de 2,495). A internação em unidade de geriatria apresentou associação inversa com uso de medicamentos potencialmente inapropriados para idosos (razão de chance de 0,513). Conclusão A frequência de prescrição de medicamentos potencialmente inapropriados para idosos na alta hospitalar foi alta. Depressão e polifarmácia estiveram diretamente associadas ao uso de medicamentos potencialmente inapropriados para idosos. Ficar internado na clínica geriátrica mostrou-se fator protetor para uso de medicamentos potencialmente inapropriados para idosos. Estratégias para melhorar a farmacoterapia do idoso devem ser implementadas, visando à qualidade assistencial e à segurança na transição do cuidado.

Emergency department visits of older adults within 30 days of discharge: analysis from the pharmacotherapy perspective / Visitas de idosos a departamentos de emergência em até 30 dias após a alta hospitalar: análise na perspectiva da farmacoterapia

ABSTRACT Objective To analyze, from the pharmacotherapy perspective, the factors associated to visits of older adults to the emergency department within 30 days after discharge. Methods A cross-sectional study carried out in a general public hospital with older adults. Emergency department visit was defined as the stay of the older adult in this service for up to 24 hours. The complexity of drug therapy was determined using the Medication Regimen Complexity Index. Potentially inappropriate drugs for use in older adults were classified according to the American Geriatric Society/Beers criteria of 2015. The outcome investigated was the frequency of visits to the emergency department within 30 days of discharge. Multivariate logistic regression was performed to identify the factors associated with the emergency department visit. Results A total of 255 elderly in the study, and 67 (26.3%) visited emergency department within 30 days of discharge. Polypharmacy and potentially inappropriate medications for older adults did not present a statistically significant association. The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with emergency department visits (OR=2.3; 95%CI: 1.04-4.94; p=0.048; and OR=2.1; 95%CI: 1.11-4.02; p=0.011), respectively. Furthermore, the diagnosis of diabetes mellitus and chronic kidney disease were protection factors for the outcome (OR=0.4; 95%CI: 0.20-0.73; p=0.004; and OR=0.3; 95%CI: 0.13-0.86; p=0.023). Conclusion The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with the occurrence of an emergency department visit within 30 days of discharge.

RESUMO Objetivo Analisar, da perspectiva da farmacoterapia, os fatores associados à visita de idosos a departamentos de emergência em até 30 dias após a alta da internação índice. Métodos Foi realizado estudo transversal em hospital público geral, com idosos. Visita a departamento de emergência foi definido como a permanência do idoso nesse serviço por até 24 horas. A complexidade da farmacoterapia foi determinada usando o Medication Regimen Complexity Index. Os medicamentos potencialmente inapropriados para idosos foram classificados segundo os critérios American Geriatric Society/Beers , de 2015. O desfecho investigado foi a frequência de visita a departamento de emergência em 30 dias após a alta hospitalar. Regressão logística multivariada foi realizada para identificar os fatores associados à visita a departamento de emergência. Resultados No estudo, foram incluídos 255 idosos; 67 (26,3%) visitaram departamento emergência em 30 dias após a alta hospitalar. Polifarmácia e medicamentos potencialmente inapropriados para idosos não apresentaram associação estatística significante. O diagnóstico de insuficiência cardíaca e o índice da complexidade da farmacoterapia >16,5 apresentaram associação positiva com visita a departamento de emergência (RC=2,3; IC95%: 1,04-4,94; p=0,048; e RC=2,1; IC95%: 1,11-4,02; p=0,011), respectivamente. Ainda, o diagnóstico de diabetes mellitus e a doença renal crônica foram fatores de proteção para o desfecho (RC=0,4; IC95%: 0,20-0,73; p=0,004; e RC=0,3; IC95%: 0,13-0,86; p=0,023). Conclusão O diagnóstico de insuficiência cardíaca e o índice da complexidade da farmacoterapia >16,5 apresentaram associação positiva com ocorrência de visita a departamento de emergência dentro de 30 dias após a alta.

Potential drug interactions in drug therapy prescribed for older adults at hospital discharge: cross-sectional study

ABSTRACT BACKGROUND: Older adults with a range of comorbidities are often prescribed multiple medications, which favors drug interactions. OBJECTIVES: To establish the frequency of potential drug interactions in prescriptions at hospital discharge among older adults and to identify the associated factors. DESIGN AND SETTING: Cross-sectional study conducted in a public hospital. METHODS: An initial face-to-face interview, data collection from the electronic medical records (covering sociodemographic, clinical, functional and drug therapy-related variables) and telephone follow-up after discharge were conducted to confirm the medication prescribed at discharge. Drug interactions were identified through the Micromedex DrugReax software, along with interactions that should be avoided among the elderly, as per the 2015 American Geriatric Society/Beers criteria. Multivariable logistic regression was performed. RESULTS: Potential for drug interactions was identified in the discharge drug therapy of 67.8% of the 255 older adults evaluated (n = 172), and 54.5% (n = 145) of the drug interactions were major. Among the drug interactions that should be avoided among older adults, those that increase the risk of falls were the most frequent. The drug interactions thus identified were independently associated with polypharmacy (odds ratio, OR = 12.62; 95% confidence interval, CI 6.25-25.50; P = 0.00), diabetes mellitus (OR = 2.16; 95% CI 1.05-4.44; P = 0.04), hypothyroidism (OR = 7.29; 95% CI 2.03-26.10; P = 0.00), chronic kidney disease (OR = 3.41; 95% CI 1.09-10.64; P = 0.03) and hospitalization in geriatric units (OR = 0.45; 95% CI 0.22-0.89; P = 0.02). CONCLUSION: The frequency of potential drug interactions in drug therapy prescribed at discharge for these older adults was high. Polypharmacy, diabetes mellitus, hypothyroidism and chronic kidney disease were positively associated with occurrences of drug interactions, while hospitalization in geriatric units showed an inverse association.