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Early rehospitalizations of frail elderly patients – the role of medications: a clinical, prospective, observational trial

BACKGROUND AND OBJECTIVE: Early readmissions of frail elderly patients after an episode of hospital care are common and constitute a crucial patient safety outcome. Our purpose was to study the impact of medications on such early rehospitalizations. PATIENTS AND METHODS: This is a clinical, prospect...

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Autores principales: Ekerstad, Niklas, Bylin, Kristoffer, Karlson, Björn W
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571818/
https://www.ncbi.nlm.nih.gov/pubmed/28860862
http://dx.doi.org/10.2147/DHPS.S139237
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author Ekerstad, Niklas
Bylin, Kristoffer
Karlson, Björn W
author_facet Ekerstad, Niklas
Bylin, Kristoffer
Karlson, Björn W
author_sort Ekerstad, Niklas
collection PubMed
description BACKGROUND AND OBJECTIVE: Early readmissions of frail elderly patients after an episode of hospital care are common and constitute a crucial patient safety outcome. Our purpose was to study the impact of medications on such early rehospitalizations. PATIENTS AND METHODS: This is a clinical, prospective, observational study on rehospitalizations within 30 days after an acute hospital episode for frail patients over the age of 75 years. To identify adverse drug reactions (ADRs), underuse of evidence-based treatment and avoidability of rehospitalizations, the Naranjo score, the Hallas criteria and clinical judgment were used. RESULTS: Of 390 evaluable patients, 96 (24.6%) were rehospitalized. The most frequent symptoms and conditions were dyspnea (n = 25) and worsened general condition (n = 18). The most frequent diagnoses were heart failure (n = 17) and pneumonia/acute bronchitis (n = 13). By logistic regression analysis, independent risk predictors for rehospitalization were heart failure (odds ratio [OR] = 1.8; 95% CI = 1.1–3.1) and anemia (OR = 2.3; 95% CI = 1.3–4.0). The number of rehospitalizations due to probable ADRs was 13, of which two were assessed as avoidable. The number of rehospitalizations probably due to underuse of evidence-based drug treatment was 19, all of which were assessed as avoidable. The number of rehospitalizations not due to ADRs or underuse of evidence-based drug treatment was 64, of which none was assessed as avoidable. CONCLUSION: One out of four frail elderly patients discharged from hospital was rehospitalized within 1 month. Although ADRs constituted an important cause of rehospitalization, underuse of evidence-based drug treatment might be an even more frequent cause. Potentially avoidable rehospitalizations were more frequently associated with underuse of evidence-based drug treatment than with ADRs. Efforts to avoid ADRs in frail elderly patients must be balanced and combined with evidence-based drug therapy, which can benefit these patients.
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spelling pubmed-55718182017-08-31 Early rehospitalizations of frail elderly patients – the role of medications: a clinical, prospective, observational trial Ekerstad, Niklas Bylin, Kristoffer Karlson, Björn W Drug Healthc Patient Saf Original Research BACKGROUND AND OBJECTIVE: Early readmissions of frail elderly patients after an episode of hospital care are common and constitute a crucial patient safety outcome. Our purpose was to study the impact of medications on such early rehospitalizations. PATIENTS AND METHODS: This is a clinical, prospective, observational study on rehospitalizations within 30 days after an acute hospital episode for frail patients over the age of 75 years. To identify adverse drug reactions (ADRs), underuse of evidence-based treatment and avoidability of rehospitalizations, the Naranjo score, the Hallas criteria and clinical judgment were used. RESULTS: Of 390 evaluable patients, 96 (24.6%) were rehospitalized. The most frequent symptoms and conditions were dyspnea (n = 25) and worsened general condition (n = 18). The most frequent diagnoses were heart failure (n = 17) and pneumonia/acute bronchitis (n = 13). By logistic regression analysis, independent risk predictors for rehospitalization were heart failure (odds ratio [OR] = 1.8; 95% CI = 1.1–3.1) and anemia (OR = 2.3; 95% CI = 1.3–4.0). The number of rehospitalizations due to probable ADRs was 13, of which two were assessed as avoidable. The number of rehospitalizations probably due to underuse of evidence-based drug treatment was 19, all of which were assessed as avoidable. The number of rehospitalizations not due to ADRs or underuse of evidence-based drug treatment was 64, of which none was assessed as avoidable. CONCLUSION: One out of four frail elderly patients discharged from hospital was rehospitalized within 1 month. Although ADRs constituted an important cause of rehospitalization, underuse of evidence-based drug treatment might be an even more frequent cause. Potentially avoidable rehospitalizations were more frequently associated with underuse of evidence-based drug treatment than with ADRs. Efforts to avoid ADRs in frail elderly patients must be balanced and combined with evidence-based drug therapy, which can benefit these patients. Dove Medical Press 2017-08-18 /pmc/articles/PMC5571818/ /pubmed/28860862 http://dx.doi.org/10.2147/DHPS.S139237 Text en © 2017 Ekerstad et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Ekerstad, Niklas
Bylin, Kristoffer
Karlson, Björn W
Early rehospitalizations of frail elderly patients – the role of medications: a clinical, prospective, observational trial
title Early rehospitalizations of frail elderly patients – the role of medications: a clinical, prospective, observational trial
title_full Early rehospitalizations of frail elderly patients – the role of medications: a clinical, prospective, observational trial
title_fullStr Early rehospitalizations of frail elderly patients – the role of medications: a clinical, prospective, observational trial
title_full_unstemmed Early rehospitalizations of frail elderly patients – the role of medications: a clinical, prospective, observational trial
title_short Early rehospitalizations of frail elderly patients – the role of medications: a clinical, prospective, observational trial
title_sort early rehospitalizations of frail elderly patients – the role of medications: a clinical, prospective, observational trial
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571818/
https://www.ncbi.nlm.nih.gov/pubmed/28860862
http://dx.doi.org/10.2147/DHPS.S139237
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