The Association of Medication Knowledge and Adherence Scores With Hospital Readmission.

Introduction: Readmission scoring systems are used to predict 30-day hospital readmission. These prediction tools do not considerlack of patient medication knowledge or adherence which can worsen disease outcomes or increase risk of readmissions. Objective: To determine if medication knowledge and adherence, as assessed by validated questionnaires, are associated with an increased rate of 30-day readmission. Methods: Adult medical inpatients were randomly selected for a prospective, single center study that was conducted from January to August 2017. Patients were asked the 4-question Morisky Green Levine Scale (MGLS) and the 4-question Medication Knowledge Score (MKS). Validated readmission score; MKS; and MGLS, as well as baseline information and readmission status within 30 days after the index admission were recorded. Mean or median scores were compared for patients readmitted within 30 days with those not readmitted using descriptive and univariate inferential statistics. Results: Data from 119 patients showed a mean age of 63 years (SD = 16). There was no difference in baseline information: age, sex, or number of scheduled home medications between those readmitted within 30 days and those not readmitted. Patients readmitted within 30 days had a statistically higher readmission score compared to patients not readmitted (66.4 vs 57.1, P = .017). There was no difference in median MKS or mean MGLS between patients readmitted within 30 days and those not readmitted (MKS: 4.0 vs 3.0, P = .753; MGLS: 1 vs 1.3, P = .162). Conclusions: In this prospective study, neither the MKS nor the MGLS scores were associated with 30-day hospital readmission.

Sustained viral suppression with co-administration of oxcarbazepine and dolutegravir.

Co-administration of dolutegravir and oxcarbazepine has been reported to reduce levels of dolutegravir and therefore is contraindicated due to insufficient data to make dosing recommendations. We present eight cases in which patients with human immunodeficiency virus (HIV) inadvertently received oxcarbazepine while concurrently receiving 50 mg of dolutegravir daily as part of their antiretroviral therapy. Upon further evaluation, lab results revealed that despite the risk of decreased levels of dolutegravir due to possible oxcarbazepine enzyme induction, patients maintained at or near virologic suppression (viral load <20 copies/ml). Suppression was maintained in patients virally suppressed prior to oxcarbazepine initiation as well as in patients receiving high doses of oxcarbazepine (>1200 mg). All patients self-reported complete adherence to oxcarbazepine and dolutegravir. Furthermore, careful review of additional patient medications suggested no other identifiable drug interactions that could have affected their antiretroviral therapy. This case series suggests that despite the well-documented drug interaction, concomitant administration of oxcarbazepine and dolutegravir in the clinical setting did not adversely affect viral suppression in patients with HIV.