Identifying medication‐related readmissions: Two students using tools vs a multidisciplinary panel

Abstract

Background: Polypharmacy may result in medication-related readmissions (MRRs).Identifying MRRs is time consuming. Screening of readmissions by students could increase efficiency for healthcare professionals. Recently, two screening tools have been published: the Assessment Tool for identifying Hospital Admissions Related to Medications (AT-HARM10) tool and the Drug-Related Admission (DRA) adjudication guide. It is unknown whether pharmacy students could identify MRRs with these tools.Objective: To compare the agreement between two pharmacy students applying the AT-HARM10 tool and DRA adjudication guide in identifying MRRs vs a multidisciplinary panel.Methods: A retrospective study was conducted from February to July 2020 at OLVG hospital. Readmissions within 30 days after discharge from seven departments were reviewed by a multidisciplinary panel (pharmacists and physicians). MRRs were defined as readmission where medication was the main cause or medication significantly contributed to the readmission. Two 5th year pharmacy-students volunteered to blindly apply both tools individually on all MRRs and a random sample of non-MRRs. The consensus results of the students and the multidisciplinary panel were compared and displayed as a percentage and Cohen's kappa (κ).Results: Three hundred sixty-six readmission cases were selected in total, consisting of 181 MRRs and 185 non-MRRs. The agreement between the students using the AT-HARM10 tool vs the multidisciplinary panel was moderate (80%, κ = 0.60 (95% confidence interval (CI): 0.52-0.68)). The DRA adjudication guide had a moderate agreement (81%, κ = 0.62 (CI: 0.54-0.70)). Students misclassified MRRs mainly because the multidisciplinary panel found disease progression more profound than a contribution of medication. Conclusions: Two students have an overall agreement of 80% in comparison withthe multidisciplinary panel with a moderate Cohen's kappa. Students are more often overestimated, but they may be a good option to preselect potential MRRs to save time for healthcare professionals. However, some MRRs will be missed.

Drug-Related Hospital Admissions via the Department of Emergency Medicine: A Cross-Sectional Study From the Czech Republic

“…In our study, there were cases of hyperkalemia associated with a reduction in kidney function due to dehydration and events that were multifactorial (hyponatremia, fall, syncope). Coppes et al (2021) have highlighted that the tools to identify DRAs have no scale to assess the medication-relatedness of hospital admission, so some cases might be identified as drug-related, but disease progression may play a larger role. Wallerstedt et al indicated that medical doctors are more likely to attribute the hospital admission to exacerbation of disease while pharmacists tend to attribute the event to ADEs ( Wallerstedt et al, 2021 ).…”

Drug-related emergency department visits in older patients: an applicability and reliability study of an existing assessment tool

“…AT-HARM10 has only been validated for use in older patients in Sweden, although successfully used in middle aged patients in a Swedish pilot study [24], and adult populations (age 18 years or older) in hospitals in Norway, Denmark and the Netherlands [25][26][27]. To reflect the novel use of AT-HARM10 to identify drug-related ED visits as presented in this study and to improve the tool's understandability, the tool and its instructions were revised based on feedback from other researchers that had used the tool and our own experience (Supplementary material).…”

Drug-related hospital admissions and emergency department visits: a feasibility study and an updated version of the AT-HARM10 assessment tool

“…ATHARM10 was used by our research group in the MedBridge trial to assess all 2391 unplanned hospital admissions [18]. Since its publication, the tool has also been used by other research groups in Sweden, Norway, Denmark and the Netherlands [14][15][16][17]. Feedback on the tool and suggestions for improvement were requested from these researchers in an unstructured and informal way.…”

“…AT-HARM10 has only been validated for use in older patients in Sweden, although successfully used in middle aged patients in a Swedish pilot study [22], and adult populations (age 18 years or older) in hospitals in Norway, Denmark and the Netherlands [14][15][16][17]. Further validation studies and examples the use of AT-HARM10 in other settings and populations may increase its external validity.…”

“…The tool was validated for use by a pair of nal-year pharmacy students in comparison to expert panel assessments, resulting in a moderate to substantial IRR and accuracy measurements between 70% and 86% [13]. Since its publication in 2018, AT-HARM10 has been used to identify possible DRAs by different research groups in Sweden, Norway, Denmark and the Netherlands [14][15][16][17]. This has raised questions about its potential use to assess ED visits instead of only hospital admissions, and an updated version to improve the tool's understandability has been requested.…”