ObjectivesTo identify aspects of medication management that are associated with a greater risk of hospital readmission.Patients and MethodsWe conducted a prospective cohort study, with a thorough medication history and reconciliation performed at admission and discharge. Patients 18 years or older (N=258) were prospectively enrolled on admission to a cardiology service at a tertiary care hospital from September 1, 2011, through July 31, 2012. All patients received their hospital and outpatient care within our institution, which minimized loss to follow-up. Readmission rates within 30 days and 6 months after discharge were recorded and used to investigate associations with specific characteristics related to medication regimen and management. Nominal logistic fit tests were used to establish associations with risk factors.ResultsA higher risk of readmission within 30 days after discharge was seen with heart failure diagnosis (P=.003) and with increased severity of comorbid conditions based on Charlson score (P=.02). Patients whose family managed their medications entirely had a higher risk of readmission at 30 days (odds ratio, 2.92; 95% CI, 1.25-5.6; P=.01) and at 6 months (odds ratio, 3.54; 95% CI, 1.70-7.65; P<.001). These findings were independent of the presence of heart failure.ConclusionPatients requiring family member support with medication management should be considered at increased risk for readmission. Increased focus on these patients at discharge may help decrease readmissions.

BACKGROUND: Hospital readmissions for cardiac diseases have a strong socio-economic impact. Medication reconciliation is one of the current interventions intended to improve quality of care, in which pharmacists play an important role. We aimed to determine risk factors and identify patients who are at risk of re-hospitalization by gathering data from the medication reconciliation process. METHODS: We included adults from our local community admitted to a medical cardiology service from September 2011 to August 2012. Two pharmacists led interviews within 48 hours of presentation. In addition to a rigorous medication reconciliation evaluation at admission and discharge, we assessed medication handling habits, adherence, familiarity with prescriptions, health literacy and reading impairment. We determined Potential Adverse Drug Events (PADE) by assessing discrepancies within medication records. Multivariate analyses were performed to look for association among factors and outcomes. RESULTS: We included 258 patients, mean age 70.5, 52 % male, 19% received help with medications, 83 % were adherent, 14% reported reading impairment, 40% heart failure (HF). The mean number of prescriptions was 7.5 and the mean Charlson comorbidity index 3.5. Medication errors reached 39% of patients on admission and 20% at discharge; no clinical complications were detected. The number of prescriptions was associated with PADEs at admission (p=0.0001) and discharge (p=0.03). Presence of PADE on admission or discharge did not affect the readmission rate. At 30 days 18% of 258 patients were readmitted, 9% visited the Emergency Department (ED) and 2.3% died; meanwhile at 6 months 38% were hospitalized, 46% went to the ED and 5.8% died. We identified a diagnosis of HF and the need for help handling medications at home as the strongest predictors of readmission at both 1 and 6 months. Other factors associated with higher readmissions rates and ED visits were the number of prescriptions, number of hospitalizations within the prior year, lack of familiarity with medical regimen and reading impairment. HF was associated with lower adherence (p=0.025); more admissions in the previous year (p=0.002), higher number of medications (p=0.001), reading impairment (p=0.02), higher readmissions at 1 and 6 months (p=0.003 and 0.0008 respectively) as well as ED visits (p=0.016) at 6 months compared with non-HF subjects. CONCLUSION: We found several characteristics, key examples being presence of HF and receipt of help with medications, that may warrant formal assessment during medication reconciliation as they seem associated with re-hospitalization. These patients may benefit from close follow-up during and post hospitalization.