Objectives To describe the prevalence of unplanned hospitalizations caused by ADRs among older Veterans and examine the association between this outcome and polypharmacy after controlling for comorbidities and other patient characteristics. Design Retrospective cohort. Setting Veterans Affairs Medical Centers (VAMC). Participants 678 randomly selected unplanned hospitalizations of older (age ≥ 65 years) Veterans between 10/01/03 and 09/30/06. Measurements Naranjo ADR algorithm, ADR preventability, and polypharmacy (0–4, 5–8, and ≥ 9 scheduled medications). Results Seventy ADRs involving 113 drugs were determined in 68 (10%) older Veterans’ hospitalizations, of which 36.8% (25/68) were preventable. Extrapolating to the population of over 2.4 million older Veterans receiving care during the study period, 8,000 hospitalizations may have been unnecessary. The most common ADRs that occurred were bradycardia (n=6; beta blockers, digoxin), hypoglycemia (n=6; sulfonylureas, insulin), falls (n=6; antidepressants, ACE-inhibitors), and mental status changes (n=6; anticonvulsants, benzodiazepines). Overall, 44.8% of Veterans took ≥ 9 outpatient medications and 35.4% took 5–8. Using multivariable logistic regression and controlling for demographic, health status, and access to care variables, polypharmacy (≥ 9 and 5–8) was associated with an increased risk of ADR-related hospitalization (AOR 3.90, 95% CI 1.43–10.61 and AOR 2.85, 95% CI 1.03–7.85, respectively). Conclusion ADRs determined by a validated causality algorithm are a common cause of unplanned hospitalization among older Veterans, are frequently preventable, and are associated with polypharmacy.

BackgroundWe examined the quality of adult epilepsy care using the Quality Indicators in Epilepsy Treatment (QUIET) measure, and variations in quality based on the source of epilepsy care.MethodsWe identified 311 individuals with epilepsy diagnosis between 2004 and 2007 in a tertiary medical center in New England. We abstracted medical charts to identify the extent to which participants received quality indicator (QI) concordant care for individual QI's and the proportion of recommended care processes completed for different aspects of epilepsy care over a two year period. Finally, we compared the proportion of recommended care processes completed for those receiving care only in primary care, neurology clinics, or care shared between primary care and neurology providers.ResultsThe mean proportion of concordant care by indicator was 55.6 (standard deviation = 31.5). Of the 1985 possible care processes, 877 (44.2%) were performed; care specific to women had the lowest concordance (37% vs. 42% [first seizure evaluation], 44% [initial epilepsy treatment], 45% [chronic care]). Individuals receiving shared care had more aspects of QI concordant care performed than did those receiving neurology care for initial treatment (53% vs. 43%; X2 = 9.0; p = 0.01) and chronic epilepsy care (55% vs. 42%; X2 = 30.2; p < 0.001).ConclusionsSimilar to most other chronic diseases, less than half of recommended care processes were performed. Further investigation is needed to understand whether a shared-care model enhances quality of care, and if so, how it leads to improvements in quality.