Risk factors for and preventability of drug‐related hospital revisits in older patients: A post‐hoc analysis of a randomized clinical trial

Thomas G. H. Kempen; Anton N. Hedman; Nermin Hadziosmanovic; Karl‐Johan Lindner; Håkan Melhus; Elisabet I. Nielsen; Johanna Sulku; Ulrika Gillespie

doi:10.1111/bcp.15621

Risk factors for and preventability of drug‐related hospital revisits in older patients: A post‐hoc analysis of a randomized clinical trial

Thomas G. H. Kempen^*, Anton N. Hedman, Nermin Hadziosmanovic, Karl‐Johan Lindner, Håkan Melhus, Elisabet I. Nielsen, Johanna Sulku, Ulrika Gillespie

^*Corresponding author for this work

Pharmacoepidemiology and Clinical Pharmacology

extern

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Aim: The aims of this study were (1) to identify older patients' risk factors for drug-related readmissions and (2) to assess the preventability of older patients' drug-related revisits. Methods: Post hoc analysis of a randomized clinical trial with patients aged ≥65 years at eight wards within four hospitals in Sweden. (1) The primary outcome was risk factors for drug-related readmission within 12 months post-discharge. A Cox proportional hazards model was made with sociodemographic and clinical baseline characteristics. (2) Four hundred trial participants were randomly selected and their revisits (admissions and emergency department visits) were assessed to identify potentially preventable drug-related revisits, related diseases and causes. Results: (1) Among 2637 patients (median age 81 years), 582 (22%) experienced a drug-related readmission within 12 months. Sixteen risk factors (hazard ratio >1, P < 0.05) related to age, previous hospital visits, medication use, multimorbidity and cardiovascular, liver, lung and peptic ulcer disease were identified. (2) The 400 patients experienced a total of 522 hospital revisits, of which 85 (16%) were potentially preventable drug-related revisits. The two most prevalent related diseases were heart failure (n = 24, 28%) and chronic obstructive pulmonary disease (n = 13, 15%). The two most prevalent causes were inadequate treatment (n = 23, 27%) and insufficient or no follow-up (n = 22, 26%). Conclusion: (1) Risk factors for drug-related readmissions in older hospitalized patients were age, previous hospital visits, medication use and multiple diseases. (2) Potentially preventable drug-related hospital revisits are common and might be prevented through adequate pharmacotherapy and continuity of care in older patients with cardiovascular or lung disease.

Original language	English
Pages (from-to)	1575-1587
Number of pages	13
Journal	British Journal of Clinical Pharmacology
Volume	89
Issue number	5
DOIs	https://doi.org/10.1111/bcp.15621
Publication status	Published - May 2023

Bibliographical note

Funding Information:
We thank all the patients who participated in the MedBridge trial, and Christine Jonsson and Marika Callmar for their help with data analysis. We would like to acknowledge the other MedBridge research group members: Maria Bertilsson, Johanna Carlsson and Åke Tenerz. This study was part of the MedBridge project, which has received government research grants RFR‐555601, RFR‐641791 and RFR‐735911 from the Uppsala‐Örebro Regional Research Council, grants LUL‐527721, LUL‐614061, LUL‐716201 and LUL‐821261 from Region Uppsala, grants CFUG‐658451 and CFUG‐698771 from Region Gävleborg, and grants LTV‐675921, LTV‐712341, LTV‐736641 and LTV‐840112 from Region Västmanland, funding from the Swedish Pharmacists Association (Sveriges Farmaceuter), the Thuréus Fund for Geriatric Research (Thuréus stiftelse för främjande av geriatrisk forskning) and the Geriatric Fund (Geriatriska fonden) and grants FA2017:38 and FA2018:43 from the Swedish Heart and Lung Association (Riksförbundet HjärtLung).

Funding Information:
We thank all the patients who participated in the MedBridge trial, and Christine Jonsson and Marika Callmar for their help with data analysis. We would like to acknowledge the other MedBridge research group members: Maria Bertilsson, Johanna Carlsson and Åke Tenerz. This study was part of the MedBridge project, which has received government research grants RFR-555601, RFR-641791 and RFR-735911 from the Uppsala-Örebro Regional Research Council, grants LUL-527721, LUL-614061, LUL-716201 and LUL-821261 from Region Uppsala, grants CFUG-658451 and CFUG-698771 from Region Gävleborg, and grants LTV-675921, LTV-712341, LTV-736641 and LTV-840112 from Region Västmanland, funding from the Swedish Pharmacists Association (Sveriges Farmaceuter), the Thuréus Fund for Geriatric Research (Thuréus stiftelse för främjande av geriatrisk forskning) and the Geriatric Fund (Geriatriska fonden) and grants FA2017:38 and FA2018:43 from the Swedish Heart and Lung Association (Riksförbundet HjärtLung).

Publisher Copyright:
© 2022 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

Keywords

causality
drug therapy
drug-related side effects and adverse reactions
hospitalization
internal medicine
patient harm

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10.1111/bcp.15621Licence: CC BY-NC

Cite this

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title = "Risk factors for and preventability of drug‐related hospital revisits in older patients: A post‐hoc analysis of a randomized clinical trial",

abstract = "Aim: The aims of this study were (1) to identify older patients' risk factors for drug-related readmissions and (2) to assess the preventability of older patients' drug-related revisits. Methods: Post hoc analysis of a randomized clinical trial with patients aged ≥65 years at eight wards within four hospitals in Sweden. (1) The primary outcome was risk factors for drug-related readmission within 12 months post-discharge. A Cox proportional hazards model was made with sociodemographic and clinical baseline characteristics. (2) Four hundred trial participants were randomly selected and their revisits (admissions and emergency department visits) were assessed to identify potentially preventable drug-related revisits, related diseases and causes. Results: (1) Among 2637 patients (median age 81 years), 582 (22%) experienced a drug-related readmission within 12 months. Sixteen risk factors (hazard ratio >1, P < 0.05) related to age, previous hospital visits, medication use, multimorbidity and cardiovascular, liver, lung and peptic ulcer disease were identified. (2) The 400 patients experienced a total of 522 hospital revisits, of which 85 (16%) were potentially preventable drug-related revisits. The two most prevalent related diseases were heart failure (n = 24, 28%) and chronic obstructive pulmonary disease (n = 13, 15%). The two most prevalent causes were inadequate treatment (n = 23, 27%) and insufficient or no follow-up (n = 22, 26%). Conclusion: (1) Risk factors for drug-related readmissions in older hospitalized patients were age, previous hospital visits, medication use and multiple diseases. (2) Potentially preventable drug-related hospital revisits are common and might be prevented through adequate pharmacotherapy and continuity of care in older patients with cardiovascular or lung disease.",

keywords = "causality, drug therapy, drug-related side effects and adverse reactions, hospitalization, internal medicine, patient harm",

author = "Kempen, {Thomas G. H.} and Hedman, {Anton N.} and Nermin Hadziosmanovic and Karl‐Johan Lindner and H{\aa}kan Melhus and Nielsen, {Elisabet I.} and Johanna Sulku and Ulrika Gillespie",

note = "Funding Information: We thank all the patients who participated in the MedBridge trial, and Christine Jonsson and Marika Callmar for their help with data analysis. We would like to acknowledge the other MedBridge research group members: Maria Bertilsson, Johanna Carlsson and {\AA}ke Tenerz. This study was part of the MedBridge project, which has received government research grants RFR‐555601, RFR‐641791 and RFR‐735911 from the Uppsala‐{\"O}rebro Regional Research Council, grants LUL‐527721, LUL‐614061, LUL‐716201 and LUL‐821261 from Region Uppsala, grants CFUG‐658451 and CFUG‐698771 from Region G{\"a}vleborg, and grants LTV‐675921, LTV‐712341, LTV‐736641 and LTV‐840112 from Region V{\"a}stmanland, funding from the Swedish Pharmacists Association (Sveriges Farmaceuter), the Thur{\'e}us Fund for Geriatric Research (Thur{\'e}us stiftelse f{\"o}r fr{\"a}mjande av geriatrisk forskning) and the Geriatric Fund (Geriatriska fonden) and grants FA2017:38 and FA2018:43 from the Swedish Heart and Lung Association (Riksf{\"o}rbundet Hj{\"a}rtLung). Funding Information: We thank all the patients who participated in the MedBridge trial, and Christine Jonsson and Marika Callmar for their help with data analysis. We would like to acknowledge the other MedBridge research group members: Maria Bertilsson, Johanna Carlsson and {\AA}ke Tenerz. This study was part of the MedBridge project, which has received government research grants RFR-555601, RFR-641791 and RFR-735911 from the Uppsala-{\"O}rebro Regional Research Council, grants LUL-527721, LUL-614061, LUL-716201 and LUL-821261 from Region Uppsala, grants CFUG-658451 and CFUG-698771 from Region G{\"a}vleborg, and grants LTV-675921, LTV-712341, LTV-736641 and LTV-840112 from Region V{\"a}stmanland, funding from the Swedish Pharmacists Association (Sveriges Farmaceuter), the Thur{\'e}us Fund for Geriatric Research (Thur{\'e}us stiftelse f{\"o}r fr{\"a}mjande av geriatrisk forskning) and the Geriatric Fund (Geriatriska fonden) and grants FA2017:38 and FA2018:43 from the Swedish Heart and Lung Association (Riksf{\"o}rbundet Hj{\"a}rtLung). Publisher Copyright: {\textcopyright} 2022 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.",

year = "2023",

month = may,

doi = "10.1111/bcp.15621",

language = "English",

volume = "89",

pages = "1575--1587",

journal = "British Journal of Clinical Pharmacology",

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Risk factors for and preventability of drug‐related hospital revisits in older patients: A post‐hoc analysis of a randomized clinical trial. / Kempen, Thomas G. H.; Hedman, Anton N.; Hadziosmanovic, Nermin et al.
In: British Journal of Clinical Pharmacology, Vol. 89, No. 5, 05.2023, p. 1575-1587.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Risk factors for and preventability of drug‐related hospital revisits in older patients

T2 - A post‐hoc analysis of a randomized clinical trial

AU - Kempen, Thomas G. H.

AU - Hedman, Anton N.

AU - Hadziosmanovic, Nermin

AU - Lindner, Karl‐Johan

AU - Melhus, Håkan

AU - Nielsen, Elisabet I.

AU - Sulku, Johanna

AU - Gillespie, Ulrika

N1 - Funding Information: We thank all the patients who participated in the MedBridge trial, and Christine Jonsson and Marika Callmar for their help with data analysis. We would like to acknowledge the other MedBridge research group members: Maria Bertilsson, Johanna Carlsson and Åke Tenerz. This study was part of the MedBridge project, which has received government research grants RFR‐555601, RFR‐641791 and RFR‐735911 from the Uppsala‐Örebro Regional Research Council, grants LUL‐527721, LUL‐614061, LUL‐716201 and LUL‐821261 from Region Uppsala, grants CFUG‐658451 and CFUG‐698771 from Region Gävleborg, and grants LTV‐675921, LTV‐712341, LTV‐736641 and LTV‐840112 from Region Västmanland, funding from the Swedish Pharmacists Association (Sveriges Farmaceuter), the Thuréus Fund for Geriatric Research (Thuréus stiftelse för främjande av geriatrisk forskning) and the Geriatric Fund (Geriatriska fonden) and grants FA2017:38 and FA2018:43 from the Swedish Heart and Lung Association (Riksförbundet HjärtLung). Funding Information: We thank all the patients who participated in the MedBridge trial, and Christine Jonsson and Marika Callmar for their help with data analysis. We would like to acknowledge the other MedBridge research group members: Maria Bertilsson, Johanna Carlsson and Åke Tenerz. This study was part of the MedBridge project, which has received government research grants RFR-555601, RFR-641791 and RFR-735911 from the Uppsala-Örebro Regional Research Council, grants LUL-527721, LUL-614061, LUL-716201 and LUL-821261 from Region Uppsala, grants CFUG-658451 and CFUG-698771 from Region Gävleborg, and grants LTV-675921, LTV-712341, LTV-736641 and LTV-840112 from Region Västmanland, funding from the Swedish Pharmacists Association (Sveriges Farmaceuter), the Thuréus Fund for Geriatric Research (Thuréus stiftelse för främjande av geriatrisk forskning) and the Geriatric Fund (Geriatriska fonden) and grants FA2017:38 and FA2018:43 from the Swedish Heart and Lung Association (Riksförbundet HjärtLung). Publisher Copyright: © 2022 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

PY - 2023/5

Y1 - 2023/5

N2 - Aim: The aims of this study were (1) to identify older patients' risk factors for drug-related readmissions and (2) to assess the preventability of older patients' drug-related revisits. Methods: Post hoc analysis of a randomized clinical trial with patients aged ≥65 years at eight wards within four hospitals in Sweden. (1) The primary outcome was risk factors for drug-related readmission within 12 months post-discharge. A Cox proportional hazards model was made with sociodemographic and clinical baseline characteristics. (2) Four hundred trial participants were randomly selected and their revisits (admissions and emergency department visits) were assessed to identify potentially preventable drug-related revisits, related diseases and causes. Results: (1) Among 2637 patients (median age 81 years), 582 (22%) experienced a drug-related readmission within 12 months. Sixteen risk factors (hazard ratio >1, P < 0.05) related to age, previous hospital visits, medication use, multimorbidity and cardiovascular, liver, lung and peptic ulcer disease were identified. (2) The 400 patients experienced a total of 522 hospital revisits, of which 85 (16%) were potentially preventable drug-related revisits. The two most prevalent related diseases were heart failure (n = 24, 28%) and chronic obstructive pulmonary disease (n = 13, 15%). The two most prevalent causes were inadequate treatment (n = 23, 27%) and insufficient or no follow-up (n = 22, 26%). Conclusion: (1) Risk factors for drug-related readmissions in older hospitalized patients were age, previous hospital visits, medication use and multiple diseases. (2) Potentially preventable drug-related hospital revisits are common and might be prevented through adequate pharmacotherapy and continuity of care in older patients with cardiovascular or lung disease.

AB - Aim: The aims of this study were (1) to identify older patients' risk factors for drug-related readmissions and (2) to assess the preventability of older patients' drug-related revisits. Methods: Post hoc analysis of a randomized clinical trial with patients aged ≥65 years at eight wards within four hospitals in Sweden. (1) The primary outcome was risk factors for drug-related readmission within 12 months post-discharge. A Cox proportional hazards model was made with sociodemographic and clinical baseline characteristics. (2) Four hundred trial participants were randomly selected and their revisits (admissions and emergency department visits) were assessed to identify potentially preventable drug-related revisits, related diseases and causes. Results: (1) Among 2637 patients (median age 81 years), 582 (22%) experienced a drug-related readmission within 12 months. Sixteen risk factors (hazard ratio >1, P < 0.05) related to age, previous hospital visits, medication use, multimorbidity and cardiovascular, liver, lung and peptic ulcer disease were identified. (2) The 400 patients experienced a total of 522 hospital revisits, of which 85 (16%) were potentially preventable drug-related revisits. The two most prevalent related diseases were heart failure (n = 24, 28%) and chronic obstructive pulmonary disease (n = 13, 15%). The two most prevalent causes were inadequate treatment (n = 23, 27%) and insufficient or no follow-up (n = 22, 26%). Conclusion: (1) Risk factors for drug-related readmissions in older hospitalized patients were age, previous hospital visits, medication use and multiple diseases. (2) Potentially preventable drug-related hospital revisits are common and might be prevented through adequate pharmacotherapy and continuity of care in older patients with cardiovascular or lung disease.

KW - causality

KW - drug therapy

KW - drug-related side effects and adverse reactions

KW - hospitalization

KW - internal medicine

KW - patient harm

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DO - 10.1111/bcp.15621

M3 - Article

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JO - British Journal of Clinical Pharmacology

JF - British Journal of Clinical Pharmacology

IS - 5

ER -

Risk factors for and preventability of drug‐related hospital revisits in older patients: A post‐hoc analysis of a randomized clinical trial

Abstract

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Keywords

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