Key result
An integrated care intervention including a medication review did not reduce potentially inappropriate medications (median 3 at discharge) but halved 30-day hospital readmissions.
Why the study?
The study was conducted to measure the impact of combining a medication review with an integrated care approach on potentially inappropriate medications and hospital readmissions in frail older adults.
Does combining a medication review with an integrated care approach reduce potentially inappropriate medications and hospital readmissions in frail older adults?
Cohort (n=582)
Does combining a medication review with an integrated care approach reduce potentially inappropriate medications and hospital readmissions in frail older adults?
An integrated care intervention including a medication review significantly reduced 30-day hospital readmissions in frail older adults, despite not reducing potentially inappropriate medications.
May support integrated care to cut readmissions in frail elderly despite unchanged PIMs; leaves open causal effects in observational data.
AIM: The objective of the present study was to measure the impact of the intervention of combining a medication review with an integrated care approach on potentially inappropriate medications (PIMs) and hospital readmissions in frail older adults. METHODS: A cohort of hospitalized older adults enrolled in the French PAERPA integrated care pathway (the exposed cohort) was matched retrospectively with hospitalized older adults not enrolled in the pathway (unexposed cohort) between January 1st, 2015, and December 31st, 2018. The study was an analysis of French health administrative database. The inclusion criteria for exposed patients were admission to an acute care department in a general hospital, age 75 years or over, at least three comorbidities or the prescription of diuretics or oral anticoagulants, discharge alive and performance of a medication review. RESULTS: For the study population (n = 582), the mean ± standard deviation age was 82.9 ± 4.9 years, and 380 (65.3%) were women. Depending on the definition used, the overall median number of PIMs ranged from 2 [0;3] on admission to 3 [0;3] at discharge. The intervention was not associated with a significant difference in the mean number of PIMs. Patients in the exposed cohort were half as likely to be readmitted to hospital within 30 days of discharge relative to patients in the unexposed cohort. CONCLUSION: Our results show that a medication review was not associated with a decrease in the mean number of PIMs. However, an integrated care intervention including the medication review was associated with a reduction in the number of hospital readmissions at 30 days.
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Payen et al. (2022) conducted a cohort in Hospitalized frail older adults (n=582). Medication review within an integrated care pathway (PAERPA) vs. Not enrolled in the pathway (unexposed cohort) was evaluated on Potentially inappropriate medications (PIMs) and hospital readmissions. An integrated care intervention including a medication review did not reduce potentially inappropriate medications (median 3 at discharge) but halved 30-day hospital readmissions.
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