Delphi study identifies priority risk indicators for 30-day medication-related readmissions, highlighting polypharmacy and communication gaps as critical targets for discharge care.
Background and Importance Medication-related readmissions (MRRs) represent a significant burden on patients and healthcare systems. Despite the relevance of MRRs, a consensus on the most important risk factors is currently lacking. Aim and Objectives This study aimed to develop a comprehensive set of indicators for 30-day MRRs through a consensus-based Delphi study. We sought to identify and prioritise key risk factors associated with MRRs. Material and Methods We assembled an expert panel consisting of clinical pharmacists, physicians, and nursing experts. The potential indicators were developed by conducting a scoping literature review (n = 20). The study team added eleven indicators not found in the existing literature but considered potentially relevant. The 31 proposed indicators were rated by the experts on a scale of 1 to 9 for relevance. Indicators with a median rating of 7 or higher were considered relevant. Consensus was determined using the RAND/UCLA method. In the second round, experts re-evaluated indicators without consensus and provided specifications for indicators requiring further detail. Results In the first round, 38 experts participated, leading to the inclusion of 25 indicators and the exclusion of six. All indicators reached consensus, and five new indicators were suggested. In the second round, 34 experts participated, resulting in the inclusion of four out of five newly proposed indicators, all of which reached consensus. The expert panel prioritised the following indicators: (1) insufficient communication between different healthcare providers, (2) polypharmacy (seven or more medications), (3) low medication adherence (forgetting or administer medications wrongly at least twice per week), (4) complex medication regimen that involves taking at least three doses per day, using at least two different dosage forms, and administering them through at least two different routes each day, and (5) multimorbidity (three or more chronic conditions). Conclusion and Relevance The comprehensive set of MRR indicators developed in this study addresses the need for a standardised MRR risk assessment and offers a tool for pharmacists to prioritise clinical pharmacy services during hospital discharge. This could lead to more efficient resource allocation and potentially improve patient outcomes. Future work will focus on validating the identified indicators. References and/or Acknowledgements Conflict of Interest No conflict of interest.
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Schönenberger et al. (2024) studied this question.
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