Medication-Related Factors and Hospital Readmission in Older Adults with Chronic Kidney Disease

This study aimed to examine the association between medication-related factors and risk of hospital readmission in older patients with chronic kidney disease (CKD). A retrospective analysis was conducted targeting older CKD (n = 204) patients admitted to an Australian hospital. Medication appropriateness (Medication Appropriateness Index; MAI), medication regimen complexity (number of medications and Medication Regimen Complexity Index; MRCI) and use of selected medication classes were exposure variables. Outcomes were occurrence of readmission within 30 and 90 days, and time to readmission within 90 days. Logistic and Cox hazards regression were used to identify factors associated with readmission. Overall, 50 patients (24%) were readmitted within 30 days, while 81 (40%) were readmitted within 90 days. Mean time to readmission within 90 days was 66 (SD 34) days. Medication appropriateness and regimen complexity were not independently associated with 30- or 90-day hospital readmissions in older adults with CKD, whereas use of renin‒angiotensin blockers was associated with reduced occurrence of 30-day (adjusted OR 0.39; 95% CI 0.19–0.79) and 90-day readmissions (adjusted OR 0.45; 95% CI 0.24–0.84) and longer time to readmission within 90 days (adjusted HR 0.52; 95% CI 0.33–0.83). This finding highlights the importance of considering the potential benefits of individual medications during medication review in older CKD patients.

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Medication Regimen Complexity and Hospital Readmission in Older Adults With Chronic Kidney Disease

Annals of Pharmacotherapy ◽

10.1177/1060028018793419 ◽

2018 ◽

Vol 53 (1) ◽

pp. 28-34 ◽

Cited By ~ 10

Author(s):

Wubshet H. Tesfaye ◽

Gregory M. Peterson ◽

Ronald L. Castelino ◽

Charlotte McKercher ◽

Matthew D. Jose ◽

...

Keyword(s):

Older Adults ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Hospital Admissions ◽

Tertiary Care ◽

Care Hospital ◽

Medication Regimen ◽

Related Factors ◽

Medication Regimen Complexity ◽

Regimen Complexity

Background: Chronic kidney disease (CKD) is characterized by high rates of hospital admissions and readmissions. However, there is a scarcity of research into medication-related factors predicting such outcomes in this patient group. Objective: To evaluate the effect of medication regimen complexity at hospital discharge on subsequent readmissions and their timing in older adults with CKD. Methods: This was a 12-month retrospective cohort study of 204 older (⩾65 years) CKD patients in an Australian tertiary care hospital. Medication regimen complexity was quantified using the 65-item medication regimen complexity index (MRCI). The outcomes were the occurrence of readmission in 30 days and time to readmission within 12 months. Logistic regression was used to identify factors predicting 30-day readmission, and a competing risks proportional subdistribution hazard model, accounting for deaths, was used for factors predicting time to readmission. Results: Overall, 50 (24%) patients, predominantly men (72%), were readmitted within 30 days of follow-up. MRCI was not significantly associated with 30-day readmission (odds ratio [OR] = 1.27; 95% CI = 0.94-1.73). The median (interquartile range) time to readmission within 12 months was 145 (31-365) days. On a multivariate analysis, a 10-unit increase in MRCI was associated with a shorter time to readmission within 12 months (subdistribution HR = 1.18; 95% CI = 1.01-1.36). Conclusion and Relevance: Medication regimen complexity was not significantly associated with 30-day readmission; however, it was associated with a significantly shorter time to 12-month readmission in older CKD patients. This finding highlights the importance of medication regimen complexity as a potential target for medical interventions to reduce readmission risks.

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Medication regimen complexity and medication adherence in elderly patients with chronic kidney disease

Hemodialysis International ◽

10.1111/hdi.12739 ◽

2019 ◽

Vol 23 (3) ◽

pp. 333-342 ◽

Cited By ~ 2

Author(s):

Krystina Parker ◽

Ingrid Bull-Engelstad ◽

Willy Aasebø ◽

Nanna von der Lippe ◽

Morten Reier-Nilsen ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Medication Adherence ◽

Kidney Disease ◽

Elderly Patients ◽

Medication Regimen ◽

Medication Regimen Complexity ◽

Regimen Complexity

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Pharmacists’ Role in Older Adults’ Medication Regimen Complexity: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168824 ◽

2021 ◽

Vol 18 (16) ◽

pp. 8824

Author(s):

Catharine Falch ◽

Gilberto Alves

Keyword(s):

Older Adults ◽

Hospital Readmission ◽

Active Role ◽

Cochrane Library ◽

Medication Regimen ◽

Medication Regimen Complexity ◽

Regimen Complexity ◽

Medication Complexity ◽

The Cochrane Library ◽

Previous Training

Medication regimen complexity (MRC) may influence health outcomes, such as hospitalisation, hospital readmission and medication adherence. Pharmacists have been referred to as health professionals with the opportunity to act on MRC reduction. This study aimed to investigate pharmacists’ role in studies about older adults’ medication regimen complexity. A literature search was performed in PubMed, Web of Science and the Cochrane Library—CENTRAL—up to October 2019. Out of 653 potentially relevant studies, 17 articles met the inclusion criteria for this review. Most studies used the 65-item medication regimen complexity index (MRCI) to assess medication complexity. Pharmacists’ role was mainly confined to data collection. It seems that pharmacists’ active role in older adults’ medication complexity has not been studied in depth so far. However, the few existing interventional ones suggest that, after previous training, regimen simplification is feasible.

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Predicting Potential Postdischarge Adverse Drug Events and 30-Day Unplanned Hospital Readmissions From Medication Regimen Complexity

Journal of Patient Safety ◽

10.1097/pts.0000000000000067 ◽

2014 ◽

Vol 10 (4) ◽

pp. 186-191 ◽

Cited By ~ 39

Author(s):

Hilary Schoonover ◽

Cynthia F. Corbett ◽

Douglas L. Weeks ◽

Megan N. Willson ◽

Stephen M. Setter

Keyword(s):

Adverse Drug Events ◽

Hospital Readmissions ◽

Medication Regimen ◽

Medication Regimen Complexity ◽

Regimen Complexity

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Medication regimen complexity in ambulatory older adults with heart failure

Clinical Interventions in Aging ◽

10.2147/cia.s130832 ◽

2017 ◽

Vol Volume 12 ◽

pp. 679-686 ◽

Cited By ~ 12

Author(s):

Michael Cobretti ◽

Robert Page II ◽

Sunny Linnebur ◽

Kimberly Deininger ◽

Amrut Ambardekar ◽

...

Keyword(s):

Heart Failure ◽

Older Adults ◽

Medication Regimen ◽

Medication Regimen Complexity ◽

Regimen Complexity

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Medication Regimen Complexity in Patients Receiving Consultant Pharmacy Services in Home Health Care

The Senior Care Pharmacist ◽

10.4140/tcp.n.2020.81 ◽

2020 ◽

Vol 35 (2) ◽

pp. 81-84

Author(s):

Megan Lenz ◽

Jeffrey A. Clark ◽

Brian J. Gates

Keyword(s):

Health Care ◽

Home Health Care ◽

Adverse Drug Events ◽

Hospital Readmissions ◽

Home Health ◽

Medication Regimen ◽

Medication Regimen Complexity ◽

Regimen Complexity ◽

Medication Complexity ◽

High Level

An interprofessional, team-based approach has become common in a variety of settings. However, consultant pharmacist participation in home health care (HHC) has been limited. To evaluate a potential need for pharmacists in HHC, the objective of this project was to document the medication complexity of patients seen by an established HHC consultant pharmacist service. This retrospective review reports on medication regimen complexity in 79 patients receiving this service using the Patient-Level Medication Regimen Complexity Index (MRCI) tool. The average MRCI score was 30 (± 15 standard deviation), suggesting a high level of medication regimen complexity in this population. High scores have been correlated with increased potential adverse drug events, 30-day hospital readmissions, and reduced adherence. Further research is needed for both the utilization of consultant pharmacists in HHC and the use of MRCI in identifying HHC patients needing pharmacist services.

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THE IMPACT OF MEDICATION REGIMEN COMPLEXITY ON ADHERENCE TO LONG-TERM THERAPIES

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2021.v14i9.42304 ◽

2021 ◽

pp. 40-43

Author(s):

SHAKEEL AHMAD MIR ◽

DANISH SHAKEEL

Keyword(s):

Drug Administration ◽

Term Therapy ◽

Medication Regimen ◽

Related Factors ◽

Cross Sectional ◽

Medication Regimen Complexity ◽

Regimen Complexity ◽

High Adherence ◽

The Impact

Objective: Adherence is a multifactorial phenomenon. Medication-related factors have long been the focus of attention. However, the results are inconsistent. Methods: In a cross-sectional questionnaire-based study of outpatients, we assessed 180 patients suffering from chronic conditions. The objective of this study is to determine the impact of medication regimen complexity on adherence to long-term drug therapies. Results: 91.66% of patients receiving more than four drugs had good or high adherence. 80.94% of patients on thrice a day (or more) drug administration had good or high adherence. 91.66% of patients receiving drug therapy for more than 5 years had good or high adherence. In all other groups, the adherence was low. The adherence was significantly (p<0.05) and positively (rs=0.792 and 0.846) correlated to the frequency of drug administration and duration of treatment. Adherence was positively correlated to the number of drugs per day (rs=0.668) but the relationships were not statistically significant (p=0.102). All the correlations were large. Conclusions: We found adherence positively correlated with medication regimen complexity. An improved understanding of the determinants of medication adherence is needed. Keywords: Medication regimen complexity, Adherence, Long-term therapy, Chronic disease

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