Drug-Related Readmissions to Medical Units of Older Adults Discharged from Acute Geriatric Units: Results of the Optimization of Medication in AGEd Multicenter Randomized Controlled Trial

Authors

  • Dominique Bonnet-Zamponi MD,

    Corresponding author
    1. Observatoire des Médicaments Dispositifs Médicaux et Innovations Thérapeutiques d'Ile de France, Paris, France
    • Département d'Epidémiologie et de Recherche Clinique, Hôpital Bichat, Assistance Publique – Hôpitaux de Paris, Paris, France
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    • Contributed equally to this work and are considered as equal first authors (see ).
  • Lydie d'Arailh MD,

    1. UFR de Médecine, Sorbonne Paris Cité, Université Paris Diderot, Paris, France
    2. Secteur Ambulatoire de Gériatrie, Hôpital Bretonneau, Assistance Publique – Hôpitaux de Paris, Paris, Paris, France
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    • Contributed equally to this work and are considered as equal first authors (see ).
  • Cécile Konrat MD,

    1. Département d'Epidémiologie et de Recherche Clinique, Hôpital Bichat, Assistance Publique – Hôpitaux de Paris, Paris, France
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  • Sandrine Delpierre MD,

    1. Secteur Ambulatoire de Gériatrie, Hôpital Bretonneau, Assistance Publique – Hôpitaux de Paris, Paris, Paris, France
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  • Deborah Lieberherr MD,

    1. Service de Gériatrie, Hôpital Bichat, Assistance Publique – Hôpitaux de Paris, Paris, France
    2. Service de Gériatrie, Hôpital Paul Brousse, Assistance Publique – Hôpitaux de Paris, Paris, Villejuif, France
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  • Aurélie Lemaire MD,

    1. Service de Gériatrie, Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Paris, Paris, France
    2. Reseau MEMORYS, Paris, France
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  • Florence Tubach MD, PhD,

    1. Département d'Epidémiologie et de Recherche Clinique, Hôpital Bichat, Assistance Publique – Hôpitaux de Paris, Paris, France
    2. UFR de Médecine, Sorbonne Paris Cité, Université Paris Diderot, Paris, France
    3. INSERM, Paris, France
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  • Sophie Lacaille MD,

    1. Service de Gériatrie, Hôpital Bichat, Assistance Publique – Hôpitaux de Paris, Paris, France
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  • Sylvie Legrain MD,

    1. UFR de Médecine, Sorbonne Paris Cité, Université Paris Diderot, Paris, France
    2. Secteur Ambulatoire de Gériatrie, Hôpital Bretonneau, Assistance Publique – Hôpitaux de Paris, Paris, Paris, France
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  • the Optimization of Medication in AGEd study group


Address correspondence to Dominique Bonnet-Zamponi, Département d'Epidémiologie et de Recherche Clinique, Assistance Publique – Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France. E-mail: dombonnet@yahoo.fr

Abstract

Objectives

To assess the effect of an intervention on drug-related problem (DRP; adverse drug reactions, adherence problems, underuse)-related readmission rates in older adults.

Design

Ancillary study from a 6-month, prospective, randomized, parallel-group, open-label trial.

Setting

Six acute geriatric units in Paris and suburbs.

Participants

Six hundred sixty-five consecutively admitted individuals were included: 317 in the intervention group (IG) and 348 in the control group (CG) (aged 86.1 ± 6.2, 66% female).

Intervention

Discharge-planning intervention combining chronic drug review, education, and enhanced transition-of-care communication.

Measurements

Chronic drugs at discharge of the two groups were compared. An expert committee blinded to group assignment adjudicated whether 6-month readmission to the study hospitals was related to drugs.

Results

Six hundred thirty-nine individuals were discharged and followed up (300 IG, 339 CG). The intervention had no significant effect on drug regimen at discharge, characterized by prescriptions that are mostly appropriate but increase iatrogenic risk. Three hundred eleven readmissions occurred during follow-up (180 CG, 131 IG), of which 185 (59.5%) were adjudicated (102 CG, 83 IG). For 16, DRP imputability was doubtful. Of the remaining 169, DRPs were the most frequent cause for readmission, with 38 (40.4%) readmissions in the CG and 26 (34.7%) in the IG (relative risk reduction = 14.3%, 95% confidence interval = 14.0–14.5%, P = .54). The intervention was associated with 39.7% fewer readmissions related to adverse drug reactions (P = .12) despite the study's lack of power.

Conclusion

Drug-related problem prevention in older people discharged from the hospital should be a priority, with a focus on improving the monitoring of drugs with high iatrogenic risk.

Ancillary