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Association between Beers' criteria-based assessment of medication use at discharge and unplanned hospital readmissions or emergency department visits among older patients |
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| รหัสดีโอไอ | |
| Title | Association between Beers' criteria-based assessment of medication use at discharge and unplanned hospital readmissions or emergency department visits among older patients |
| Creator | Watcharasak Sombut |
| Contributor | Arom Jedsadayanmata, Advisor |
| Publisher | Thammasat University |
| Publication Year | 2568 |
| Keyword | Early readmission, Potentially inappropriate medications, PIMs, Older adults, Unplanned visits |
| Abstract | Background: Evidence on the association between potentially inappropriate medications (PIMs) and adverse outcomes after hospital discharge remains limited and contradictory. This study aimed to determine the prevalence, predictors, and impact of PIMs at discharge on early unplanned readmissions and emergency department (ED) visits in older adults.Methods: This retrospective cohort study analyzed electronic medical records of older patients discharged from a tertiary-care hospital to home. Prevalence of PIMs was determined with the 2023 Beers’ criteria. Predictors were determined with logistic regression. Patients were followed for 90 days to assess unplanned readmissions and ED visits. Multiple Cox regression and parametric survival analysis determined the association between PIMs and early readmissions/ED visits.Results: Among 4,012 older patients, 2,299 (57.3%) were discharged with at least one PIM. Factors independently associated with PIM use included a higher Charlson Comorbidity Index (OR 1.08, 95% CI 1.01–1.15, p=0.02), longer hospital stay (OR 1.01, 95% CI 1.00–1.02, p=0.01), and a greater number of discharge medications (OR 1.26, 95% CI 1.24–1.29, p<0.001). Within 90 days post-discharge, unplanned readmissions or ED visits occurred in 183 of 2,299 (7.96%) patients with PIMs and 89 of 1,713 (5.20%) without PIMs. In multivariable Cox regression, PIM use was associated with a non-significant increase in the risk of unplanned readmissions and ED visits (HR 1.15, 95% CI 0.87–1.51, p = 0.32), a finding consistent across parametric survival models using Weibull, exponential, lognormal, and log-logistic distributions.Conclusion: PIMs were highly prevalent in older patients at discharge, with comorbidity burden, the duration of hospital stays, and polypharmacy as significant predictors. However, PIMs were not significantly associated with early unplanned readmissions or unplanned readmissions and ED visits. |
