Key result
In older inpatients prescribed 5 to 9 discharge medications, decreasing potentially inappropriate medications reduced the risk of 28-day ED visits (aOR 0.55; 95% CI 0.34-0.91; P=0.02).
Why the study?
Medication review is integral in older inpatients, but the association of in-hospital medication changes with 28-day postdischarge clinical outcomes needed assessment.
Do in-hospital medication changes reduce 28-day postdischarge ED visits, readmissions, and mortality in older inpatients?
Cohort (n=2,000)
Do in-hospital medication changes reduce 28-day postdischarge ED visits, readmissions, and mortality in older inpatients?
Odds Ratio: 0.55 (95% CI 0.34–0.91)
p-value: p=.02
In-hospital medication changes, specifically decreasing potentially inappropriate medications, are associated with reduced 28-day ED visits and readmissions in older inpatients discharged on 5 to 9 medications.
In-hospital medication changes were associated with fewer 28-day ED visits in moderate polypharmacy; leaves open whether targeted reviews improve postdischarge safety.
BACKGROUND: Medication review is integral in the pharmacological management of older inpatients. OBJECTIVE: To assess the association of in-hospital medication changes with 28-day postdischarge clinical outcomes. METHODS: Retrospective cohort of 2000 inpatients aged ≥75 years. Medication changes included the number of increases (medications started or dose-increased) and decreases (medications stopped or dose-decreased) for (i) all medications, (ii) Drug Burden Index (DBI)-contributing medications and (iii) Beers Criteria 2015 medications (potentially inappropriate medications, PIMs). Changes also included differences in (i) the number of medications, (ii) the number of PIMs and (iii) DBI score, at discharge versus admission. Associations with clinical outcomes (28-day ED visit, readmission and mortality) were ascertained using logistic regression, adjusted for age, gender and principal diagnosis. For mortality, sensitivity analysis excluded end-of-life patients due to higher death risk. Patients were stratified into : (i) ≤4, (ii) 5-9 and (iii) ≥10 discharge medications. RESULTS: The mean age was 86 years (SD = 5.8), with 59.1% female. Medication changes reduced ED visits and readmission risk for patients prescribed five to nine discharge medications, with no associations in patients prescribed ≤4 and ≥ 10 medications. In the five to nine medications group, decreasing PIMs reduced risks of ED visit (adjusted odds ratio, aOR 0.55, 95% CI 0.34-0.91, P = .02) and readmission (aOR 0.62, 95% CI 0.38-0.99, P = .04). Decreasing DBI-contributing medications reduced readmission risk (aOR 0.71, 95% CI 0.51-0.99, P = .04). Differences in PIMs reduced ED visit risk (aOR 0.65, 95% CI 0.43-0.99, P = .04). There were no associations with mortality in sensitivity analyses in all groups. DISCUSSION: Medication changes were associated with reduced ED visits and readmission for patients prescribed five to nine discharge medications.
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Masnoon et al. (2025) conducted a cohort in older inpatients (n=2,000). In-hospital medication changes was evaluated on 28-day ED visit (aOR 0.55, 95% CI 0.34-0.91, p=.02). In older inpatients prescribed 5 to 9 discharge medications, decreasing potentially inappropriate medications reduced the risk of 28-day ED visits (aOR 0.55; 95% CI 0.34-0.91; P=0.02).
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