Association between potentially inappropriate medications at discharge and unplanned readmissions among hospitalised elderly patients at a single centre in Japan: a prospective observational study

Abstract

ObjectiveTo determine the prevalence of potentially inappropriate medication (PIM) use at admission and discharge among hospitalised elderly patients and evaluate the association between PIMs at discharge and unplanned readmission in Japan.DesignA prospective observational study conducted by using electronic medical records.ParticipantsAll consecutive patients aged 65 years or older who were admitted to the internal medicine ward were included. Patients who were electively admitted for diagnostic procedures were excluded.Main outcome measuresThe primary outcome was 30-day unplanned readmissions. The secondary outcome was the prevalence of any PIM use at admission and discharge. PIMs were defined based on the Beers Criteria. The association between any PIM use at discharge and the primary outcome was evaluated by using logistic regression.ResultsSeven hundred thirty-nine eligible patients were included in this study. The median patient age was 82 years (IQR 74–88); 389 (52.6%) were women, and the median Charlson Comorbidity Index was 2 (IQR 0–3). The proportions of patients taking any PIMs at admission and discharge were 47.2% and 32.2%, respectively. Of all the patients, 39 (5.3%) were readmitted within 30 days after discharge for the index hospitalisation. The use of PIMs at discharge was not associated with an increased risk of 30-day readmission (OR 0.93; 95% CI 0.46 to 1.87). This result did not change after adjusting for patient age, sex, number of medications, duration of hospital stay and comorbidities (OR 0.78; 95% CI 0.36 to 1.66).ConclusionThe prevalence of any PIM use at discharge was high among hospitalised elderly patients in a Japanese hospital. Although the use of PIMs at discharge was not associated with an increased risk of unplanned readmission, given a lack of power of this study due to a low event rate, further studies investigating this association are needed.Trial registration numberUMIN000027189.

Association of Self-Reported Medication Adherence with Potentially Inappropriate Medications in Elderly Patients: A Cross-Sectional Pilot Study

“…Furthermore, our study demonstrated that there is also a significant association between PP and PIM use, which is supported by previous reports [8,[20][21][22][23][24][25][26][27]. The frequency of elderly PIM(+) patients in Japan varies from 22.9% to 67.3% [8,22,23,27,31,35,68,71,72] because of different study populations and settings, different definitions of PIMs, or different timings of the investigation.…”

“…Lastly, 64.1% and 56.3% patients had polypharmacy and at least one PIM, respectively, but these percentages may be difficult to compare to the previous reports, because we excluded individuals admitted for an emergency or unable to self-medicate. In previous studies which examined individuals using PP and PIMs, it is likely that the incidence rate of unplanned re-admissions and advanced cognitive impairment are associated with PP and PIMs [67,72]. Furthermore, we did not examine the administration period of the combined use of multiple antithrombotic agents, which may have been overestimated in the percentage of PIMs.…”

Potentially inappropriate prescribing and its associations with health‐related and system‐related outcomes in hospitalised older adults: A systematic review and meta‐analysis

“…Of these, 103 articles were excluded, mainly because studies reported a different outcome of interest ( n = 58). The final screening identified 63 studies 33–95 suitable for inclusion in this review (Figure 1).…”

The impact of a multifaceted intervention to reduce potentially inappropriate prescribing among discharged older adults: a before-and-after study

“…Beers and STOPP criteria address potentially inappropriate medications (PIMs), while START criteria discuss potential prescribing omissions (PPOs). The prevalence of PIP is quite high in older adults, and it is well established that PIP increases the incidence of ADRs and drug related hospitalization in this population [ 4 , 5 ]. Hospital admissions should provide a good incentive for HCPs to optimize medications of hospitalized patients.…”