Family Help With Medication Management: A Predictive Marker for Early Readmission

OBJECTIVES: To identify aspects of medication management that are associated with a greater risk of hospital readmission. PATIENTS AND METHODS: We conducted a prospective cohort study, with a thorough medication history and reconciliation performed at admission and discharge. Patients 18 years or older (N=258) were prospectively enrolled on admission to a cardiology service at a tertiary care hospital from September 1, 2011, through July 31, 2012. All patients received their hospital and outpatient care within our institution, which minimized loss to follow-up. Readmission rates within 30 days and 6 months after discharge were recorded and used to investigate associations with specific characteristics related to medication regimen and management. Nominal logistic fit tests were used to establish associations with risk factors. RESULTS: A higher risk of readmission within 30 days after discharge was seen with heart failure diagnosis (P=.003) and with increased severity of comorbid conditions based on Charlson score (P=.02). Patients whose family managed their medications entirely had a higher risk of readmission at 30 days (odds ratio, 2.92; 95% CI, 1.25-5.6; P=.01) and at 6 months (odds ratio, 3.54; 95% CI, 1.70-7.65; P<.001). These findings were independent of the presence of heart failure. CONCLUSION: Patients requiring family member support with medication management should be considered at increased risk for readmission. Increased focus on these patients at discharge may help decrease readmissions.