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Incidence and cost of medication harm in older adults following hospital discharge: A multicentre prospective study in the UK

Incidence and cost of medication harm in older adults following hospital discharge: A multicentre prospective study in the UK
Incidence and cost of medication harm in older adults following hospital discharge: A multicentre prospective study in the UK

Aims: Polypharmacy is increasingly common in older adults, placing them at risk of medication-related harm (MRH). Patients are particularly vulnerable to problems with their medications in the period following hospital discharge due to medication changes and poor information transfer between hospital and primary care. The aim of the present study was to investigate the incidence, severity, preventability and cost of MRH in older adults in England postdischarge. Methods: An observational, multicentre, prospective cohort study recruited 1280 older adults (median age 82 years) from five teaching hospitals in Southern England, UK. Participants were followed up for 8 weeks by senior pharmacists, using three data sources (hospital readmission review, participant telephone interview and primary care records), to identify MRH and associated health service utilization. Results: Overall, 413 participants (37%) experienced MRH (556 MRH events per 1000 discharges), of which 336 (81%) cases were serious and 214 (52%) potentially preventable. Four participants experienced fatal MRH. The most common MRH events were gastrointestinal (n = 158, 25%) or neurological (n = 111, 18%). The medicine classes associated with the highest risk of MRH were opiates, antibiotics and benzodiazepines. A total of 328 (79%) participants with MRH sought healthcare over the 8-week follow-up. The incidence of MRH-associated hospital readmission was 78 per 1000 discharges. Postdischarge MRH in older adults is estimated to cost the National Health Service £396 million annually, of which £243 million is potentially preventable. Conclusions: MRH is common in older adults following hospital discharge, and results in substantial use of healthcare resources.

Health economics, Health service use, Hospital discharge, Medication harm, Older adults, Pharmacoepidemiology
0306-5251
Parekh, Nikesh
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Ali, Khalid
829689bd-60d0-4172-af7a-8c9795a13998
Stevenson, Jennifer M.
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Davies, J. Graham
c04c519c-923b-47f9-968f-211be69e2abb
Schiff, Rebekah
bbdc8647-ba09-4a30-a01d-3ce8734ef9ea
Van der Cammen, Tischa
5d541aac-2685-47e0-b902-c01f39d74a96
Harchowal, Jatinder
893d4699-afa9-431c-92f9-e2faf400ec05
Raftery, James
27c2661d-6c4f-448a-bf36-9a89ec72bd6b
Rajkumar, Chakravarthi
c41da05d-084f-4dd2-aaa7-03607e52a0ef
Parekh, Nikesh
580bf4fd-67a0-464a-8fa8-2d0399202f90
Ali, Khalid
829689bd-60d0-4172-af7a-8c9795a13998
Stevenson, Jennifer M.
8c2f4d06-e3bc-485b-8835-838706e89270
Davies, J. Graham
c04c519c-923b-47f9-968f-211be69e2abb
Schiff, Rebekah
bbdc8647-ba09-4a30-a01d-3ce8734ef9ea
Van der Cammen, Tischa
5d541aac-2685-47e0-b902-c01f39d74a96
Harchowal, Jatinder
893d4699-afa9-431c-92f9-e2faf400ec05
Raftery, James
27c2661d-6c4f-448a-bf36-9a89ec72bd6b
Rajkumar, Chakravarthi
c41da05d-084f-4dd2-aaa7-03607e52a0ef

Parekh, Nikesh, Ali, Khalid, Stevenson, Jennifer M., Davies, J. Graham, Schiff, Rebekah, Van der Cammen, Tischa, Harchowal, Jatinder, Raftery, James and Rajkumar, Chakravarthi (2018) Incidence and cost of medication harm in older adults following hospital discharge: A multicentre prospective study in the UK. British Journal of Clinical Pharmacology. (doi:10.1111/bcp.13613).

Record type: Article

Abstract

Aims: Polypharmacy is increasingly common in older adults, placing them at risk of medication-related harm (MRH). Patients are particularly vulnerable to problems with their medications in the period following hospital discharge due to medication changes and poor information transfer between hospital and primary care. The aim of the present study was to investigate the incidence, severity, preventability and cost of MRH in older adults in England postdischarge. Methods: An observational, multicentre, prospective cohort study recruited 1280 older adults (median age 82 years) from five teaching hospitals in Southern England, UK. Participants were followed up for 8 weeks by senior pharmacists, using three data sources (hospital readmission review, participant telephone interview and primary care records), to identify MRH and associated health service utilization. Results: Overall, 413 participants (37%) experienced MRH (556 MRH events per 1000 discharges), of which 336 (81%) cases were serious and 214 (52%) potentially preventable. Four participants experienced fatal MRH. The most common MRH events were gastrointestinal (n = 158, 25%) or neurological (n = 111, 18%). The medicine classes associated with the highest risk of MRH were opiates, antibiotics and benzodiazepines. A total of 328 (79%) participants with MRH sought healthcare over the 8-week follow-up. The incidence of MRH-associated hospital readmission was 78 per 1000 discharges. Postdischarge MRH in older adults is estimated to cost the National Health Service £396 million annually, of which £243 million is potentially preventable. Conclusions: MRH is common in older adults following hospital discharge, and results in substantial use of healthcare resources.

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Parekh_et_al-2018-British_Journal_of_Clinical_Pharmacology - Version of Record
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Accepted/In Press date: 8 April 2018
e-pub ahead of print date: 22 May 2018
Keywords: Health economics, Health service use, Hospital discharge, Medication harm, Older adults, Pharmacoepidemiology

Identifiers

Local EPrints ID: 421463
URI: http://eprints.soton.ac.uk/id/eprint/421463
ISSN: 0306-5251
PURE UUID: 1edf53f2-a848-460f-9a36-6b56828da79f

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Date deposited: 13 Jun 2018 16:30
Last modified: 16 Dec 2019 18:09

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