Objectives To characterize adverse drug events (ADEs) occurring within the high-risk 45-day period post-hospitalization in older adults. Design Clinical pharmacists reviewed the ambulatory records of 1000 consecutive discharges. Setting A large multispecialty group practice closely aligned with a Massachusetts-based health plan. Participants Hospitalized patients aged 65 years and older who were discharged to home. Measurements Possible drug-related incidents occurring during the 45-day period post-hospitalization were identified and presented to a pair of physician-reviewers who classified incidents as to whether an ADE was present, whether the event was preventable, and the severity of the event. Medications implicated in ADEs were further characterized according to their inclusion in the 2012 Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Results At least one ADE was identified during the 45-day period in 18.7% (187) of the 1000 discharges. Of the 242 ADEs identified, 35% (n=84) were deemed preventable, of which 32% (n=27) were characterized as serious, and 5% (n=4) as life threatening. Over half of all ADEs occurred within the first 14 days post-hospitalization. The percentage of ADEs in which Beers Criteria medications were implicated was 16.5% (n=40). Beers Criteria medications with both a high quality of evidence and strong strength of recommendation were implicated in 6.6% (n=16) of the ADEs. Conclusion ADEs are common and often preventable among older adults following hospital discharge, underscoring the need to address medication safety during this high-risk period in this vulnerable population. Beers Criteria medications played a small role in these events suggesting that efforts to improve the quality and safety of medication use during this critical transition period must extend beyond a singular focus on Beers criteria medications.

Background/Objectives We assessed the impact of an electronic health record-based transitional care intervention involving automated alerts to primary care providers and staff when older patients were discharged from the hospital. Design Randomized controlled trial. Setting A large multispecialty group practice. Participants Patients aged 65 or older discharged from hospital to home. Intervention In addition to notifying primary care providers about the patient's recent discharge, the system provided information about new drugs added during the inpatient stay, warnings about drug-drug interactions, and recommendations for dose changes and laboratory monitoring of high-risk medications, as well as alerts to the primary care provider's support staff to schedule a post-hospitalization office visit. Measurements An outpatient office visit with a primary care provider following discharge and rehospitalization within 30 days following discharge. Results Of the 1870 discharges in the intervention group, 27.7% had an office visit with a primary care provider within 7 days of discharge. Of the 1,791 discharges in the control group, 28.3% had an office visit with a primary care provider within 7 days of discharge. In the intervention group, 18.8% experienced a rehospitalization within the 30-day period post-discharge compared with 19.9% in the control group. The hazard ratio for an office visit with a primary care physician did not significantly differ between the intervention and control groups. The hazard ratio for rehospitalization in the 30-day period following hospital discharge in the intervention versus the control group was 0.94 (95% confidence interval: 0.81, 1.1). Conclusion We did not demonstrate a significant effect of this electronic health record-based intervention in increasing the timeliness of office visits to primary care providers following hospitalization, or reducing risk of rehospitalization.

Workplace exacerbation of asthma was common in this study population, occurring in over a fifth of these adults with asthma. Physicians should consider that work can contribute to the exacerbation of symptoms when treating adults with asthma.

Objective: To determine the validity of work-related self-reported exacerbation of asthma using the findings from serial peak expiratory flow (PEF) measurements as the standard. Methods: Adults with asthma treated in a health maintenance organisation were asked to conduct serial spirometry testing at home and at work for 3 weeks. Self-reported respiratory symptoms and medication use were recorded in two ways: a daily log completed concurrently with the serial PEF testing and a telephone questionnaire administered after the PEF testing. Three researchers evaluated the serial PEF records and judged whether a work relationship was evident. Results: 95 of 382 (25%) working adults with asthma provided adequate serial PEF data, and 13 of 95 (14%) were judged to have workplace exacerbation of asthma (WEA) based on these data. Self-reported concurrent medication use was the most valid single operational definition, with a sensitivity of 62% and a specificity of 65%. Conclusions: A work-related pattern of self-reported asthma symptoms or medication use was usually not corroborated by serial PEF testing and failed to identify many people who had evidence of WEA based on the serial PEF measurements.