Impact of potentially inappropriate medications and polypharmacy on 3-month readmission among older patients discharged from acute care hospital: a prospective study

Paolo Fabbietti, Giuseppina Di Stefano, Raffaella Moresi, Laura Cassetta, Mirko Di Rosa, Filippo Fimognari, Valentina Bambara, Giovanni Ruotolo, Alberto Castagna, Carmen Ruberto, Fabrizia Lattanzio, Andrea Corsonello

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Polypharmacy and potentially inappropriate medications (PIMs) are known to affect several negative outcomes in older patients. However, studies comparatively assessing polypharmacy and PIMs in relation to readmission are distinctively lacking. Aims: To compare the impact of polypharmacy and PIMs on 3-month readmission among older patients discharged from acute care hospital. Methods: Our series consisted of 647 patients consecutively enrolled in a multicenter observational study. The outcome of the study was the occurrence of any admission during the 3-month follow-up after discharge. Polypharmacy was defined as use of more than eight medications. PIMs were identified using 2015 version of Beers and Screening Tool of Older Persons Prescriptions (STOPP) criteria. Statistical analysis was performed using logistic regression models. Results: After adjusting for potential confounders, polypharmacy (OR 2.72, 95% CI 1.48–4.99) was found associated with the outcome, while Beers (OR 0.85, 95% CI 0.46–1.56), STOPP (OR 1.60, 95% CI 0.85–3.01), or combined Beers and STOPP violations (OR 0.99, 95% CI 0.57–1.74) were not. The association between polypharmacy and 3-month readmission was confirmed in logistic regression models including Beers (OR 2.88, 95% CI 1.55–5.34), STOPP (OR 2.64, 95% CI 1.43–4.87), or combined Beers and STOPP violations (OR 2.80, 95% CI 1.51–5.21). Discussion: Besides confirming that polypharmacy should be considered as a marker for readmission risk among older patients discharged from acute care hospital, our findings suggest that the association between polypharmacy and 3-month readmission is substantially independent of use of PIMs. Conclusions: Polypharmacy, but not PIMs was significantly associated with readmission. Hospitalization should always be considered as a clue to individuate unnecessary polypharmacy and to reduce the burden of medications whenever possible.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalAging clinical and experimental research
DOIs
Publication statusE-pub ahead of print - Nov 11 2017

Fingerprint

Polypharmacy
Prospective Studies
Prescriptions
Logistic Models
Potentially Inappropriate Medication List
Multicenter Studies
Observational Studies
Hospitalization
Outcome Assessment (Health Care)

Keywords

  • Beers criteria
  • Hospital
  • Older patients
  • Readmission
  • Screening Tool of Older Persons Prescriptions (STOPP) criteria

ASJC Scopus subject areas

  • Ageing
  • Geriatrics and Gerontology

Cite this

@article{53b96e06e01c41fa9f980079a56f209c,
title = "Impact of potentially inappropriate medications and polypharmacy on 3-month readmission among older patients discharged from acute care hospital: a prospective study",
abstract = "Background: Polypharmacy and potentially inappropriate medications (PIMs) are known to affect several negative outcomes in older patients. However, studies comparatively assessing polypharmacy and PIMs in relation to readmission are distinctively lacking. Aims: To compare the impact of polypharmacy and PIMs on 3-month readmission among older patients discharged from acute care hospital. Methods: Our series consisted of 647 patients consecutively enrolled in a multicenter observational study. The outcome of the study was the occurrence of any admission during the 3-month follow-up after discharge. Polypharmacy was defined as use of more than eight medications. PIMs were identified using 2015 version of Beers and Screening Tool of Older Persons Prescriptions (STOPP) criteria. Statistical analysis was performed using logistic regression models. Results: After adjusting for potential confounders, polypharmacy (OR 2.72, 95{\%} CI 1.48–4.99) was found associated with the outcome, while Beers (OR 0.85, 95{\%} CI 0.46–1.56), STOPP (OR 1.60, 95{\%} CI 0.85–3.01), or combined Beers and STOPP violations (OR 0.99, 95{\%} CI 0.57–1.74) were not. The association between polypharmacy and 3-month readmission was confirmed in logistic regression models including Beers (OR 2.88, 95{\%} CI 1.55–5.34), STOPP (OR 2.64, 95{\%} CI 1.43–4.87), or combined Beers and STOPP violations (OR 2.80, 95{\%} CI 1.51–5.21). Discussion: Besides confirming that polypharmacy should be considered as a marker for readmission risk among older patients discharged from acute care hospital, our findings suggest that the association between polypharmacy and 3-month readmission is substantially independent of use of PIMs. Conclusions: Polypharmacy, but not PIMs was significantly associated with readmission. Hospitalization should always be considered as a clue to individuate unnecessary polypharmacy and to reduce the burden of medications whenever possible.",
keywords = "Beers criteria, Hospital, Older patients, Readmission, Screening Tool of Older Persons Prescriptions (STOPP) criteria",
author = "Paolo Fabbietti and {Di Stefano}, Giuseppina and Raffaella Moresi and Laura Cassetta and {Di Rosa}, Mirko and Filippo Fimognari and Valentina Bambara and Giovanni Ruotolo and Alberto Castagna and Carmen Ruberto and Fabrizia Lattanzio and Andrea Corsonello",
year = "2017",
month = "11",
day = "11",
doi = "10.1007/s40520-017-0856-y",
language = "English",
pages = "1--8",
journal = "Aging clinical and experimental research",
issn = "1594-0667",
publisher = "Springer International Publishing AG",

}

TY - JOUR

T1 - Impact of potentially inappropriate medications and polypharmacy on 3-month readmission among older patients discharged from acute care hospital

T2 - a prospective study

AU - Fabbietti, Paolo

AU - Di Stefano, Giuseppina

AU - Moresi, Raffaella

AU - Cassetta, Laura

AU - Di Rosa, Mirko

AU - Fimognari, Filippo

AU - Bambara, Valentina

AU - Ruotolo, Giovanni

AU - Castagna, Alberto

AU - Ruberto, Carmen

AU - Lattanzio, Fabrizia

AU - Corsonello, Andrea

PY - 2017/11/11

Y1 - 2017/11/11

N2 - Background: Polypharmacy and potentially inappropriate medications (PIMs) are known to affect several negative outcomes in older patients. However, studies comparatively assessing polypharmacy and PIMs in relation to readmission are distinctively lacking. Aims: To compare the impact of polypharmacy and PIMs on 3-month readmission among older patients discharged from acute care hospital. Methods: Our series consisted of 647 patients consecutively enrolled in a multicenter observational study. The outcome of the study was the occurrence of any admission during the 3-month follow-up after discharge. Polypharmacy was defined as use of more than eight medications. PIMs were identified using 2015 version of Beers and Screening Tool of Older Persons Prescriptions (STOPP) criteria. Statistical analysis was performed using logistic regression models. Results: After adjusting for potential confounders, polypharmacy (OR 2.72, 95% CI 1.48–4.99) was found associated with the outcome, while Beers (OR 0.85, 95% CI 0.46–1.56), STOPP (OR 1.60, 95% CI 0.85–3.01), or combined Beers and STOPP violations (OR 0.99, 95% CI 0.57–1.74) were not. The association between polypharmacy and 3-month readmission was confirmed in logistic regression models including Beers (OR 2.88, 95% CI 1.55–5.34), STOPP (OR 2.64, 95% CI 1.43–4.87), or combined Beers and STOPP violations (OR 2.80, 95% CI 1.51–5.21). Discussion: Besides confirming that polypharmacy should be considered as a marker for readmission risk among older patients discharged from acute care hospital, our findings suggest that the association between polypharmacy and 3-month readmission is substantially independent of use of PIMs. Conclusions: Polypharmacy, but not PIMs was significantly associated with readmission. Hospitalization should always be considered as a clue to individuate unnecessary polypharmacy and to reduce the burden of medications whenever possible.

AB - Background: Polypharmacy and potentially inappropriate medications (PIMs) are known to affect several negative outcomes in older patients. However, studies comparatively assessing polypharmacy and PIMs in relation to readmission are distinctively lacking. Aims: To compare the impact of polypharmacy and PIMs on 3-month readmission among older patients discharged from acute care hospital. Methods: Our series consisted of 647 patients consecutively enrolled in a multicenter observational study. The outcome of the study was the occurrence of any admission during the 3-month follow-up after discharge. Polypharmacy was defined as use of more than eight medications. PIMs were identified using 2015 version of Beers and Screening Tool of Older Persons Prescriptions (STOPP) criteria. Statistical analysis was performed using logistic regression models. Results: After adjusting for potential confounders, polypharmacy (OR 2.72, 95% CI 1.48–4.99) was found associated with the outcome, while Beers (OR 0.85, 95% CI 0.46–1.56), STOPP (OR 1.60, 95% CI 0.85–3.01), or combined Beers and STOPP violations (OR 0.99, 95% CI 0.57–1.74) were not. The association between polypharmacy and 3-month readmission was confirmed in logistic regression models including Beers (OR 2.88, 95% CI 1.55–5.34), STOPP (OR 2.64, 95% CI 1.43–4.87), or combined Beers and STOPP violations (OR 2.80, 95% CI 1.51–5.21). Discussion: Besides confirming that polypharmacy should be considered as a marker for readmission risk among older patients discharged from acute care hospital, our findings suggest that the association between polypharmacy and 3-month readmission is substantially independent of use of PIMs. Conclusions: Polypharmacy, but not PIMs was significantly associated with readmission. Hospitalization should always be considered as a clue to individuate unnecessary polypharmacy and to reduce the burden of medications whenever possible.

KW - Beers criteria

KW - Hospital

KW - Older patients

KW - Readmission

KW - Screening Tool of Older Persons Prescriptions (STOPP) criteria

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