TY - JOUR
T1 - A multi-centre cohort study on healthcare use due to medication-related harm
T2 - the role of frailty and polypharmacy
AU - Stevenson, Jennifer M
AU - Parekh, Nikesh
AU - Chua, Kia-Chong
AU - Davies, J Graham
AU - Schiff, Rebekah
AU - Rajkumar, Chakravarthi
AU - Ali, Khalid
PY - 2022/3/1
Y1 - 2022/3/1
N2 - ObjectivesTo determine the association between frailty and medication-related harm requiring healthcare utilisation.DesignProspective observational cohort study.SettingSix primary and five secondary care sites across South East England, September 2013-November 2015.ParticipantsOne thousand and two hundred and eighty participants, ≥65 years old, who were due for discharge from general medicine and older persons' wards following an acute episode of care. Exclusion criteria were limited life expectancy, transfer to another hospital and consent not gained.Main outcome measuresMedication-related harm requiring healthcare utilisation (including primary, secondary or tertiary care consultations related to MRH), including adverse drug reactions, non-adherence and medication error determined via the review of data from three sources: patient/carer reports gathered through a structured telephone interview; primary care medical record review; and prospective consultant-led review of readmission to recruiting hospital. Frailty was measured using a Frailty Index, developed using a standardised approach. Marginal estimates were obtained from logistic regression models to examine how probabilities of healthcare service use due to medication-related harm were associated with increasing number of medicines and frailty.ResultsHealthcare utilisation due to medication-related harm was significantly associated with frailty (OR = 10.06, 95% CI 2.06-49.26, P = 0.004), independent of age, gender, and number of medicines. With increasing frailty, the need for healthcare use as a result of MRH increases from a probability of around 0.2-0.4. This is also the case for the number of medicines.ConclusionsFrailty is associated with MRH, independent of polypharmacy. Reducing the burden of frailty through an integrated health and social care approach, alongside strategies to reduce inappropriate polypharmacy, may reduce MRH related healthcare utilisation.
AB - ObjectivesTo determine the association between frailty and medication-related harm requiring healthcare utilisation.DesignProspective observational cohort study.SettingSix primary and five secondary care sites across South East England, September 2013-November 2015.ParticipantsOne thousand and two hundred and eighty participants, ≥65 years old, who were due for discharge from general medicine and older persons' wards following an acute episode of care. Exclusion criteria were limited life expectancy, transfer to another hospital and consent not gained.Main outcome measuresMedication-related harm requiring healthcare utilisation (including primary, secondary or tertiary care consultations related to MRH), including adverse drug reactions, non-adherence and medication error determined via the review of data from three sources: patient/carer reports gathered through a structured telephone interview; primary care medical record review; and prospective consultant-led review of readmission to recruiting hospital. Frailty was measured using a Frailty Index, developed using a standardised approach. Marginal estimates were obtained from logistic regression models to examine how probabilities of healthcare service use due to medication-related harm were associated with increasing number of medicines and frailty.ResultsHealthcare utilisation due to medication-related harm was significantly associated with frailty (OR = 10.06, 95% CI 2.06-49.26, P = 0.004), independent of age, gender, and number of medicines. With increasing frailty, the need for healthcare use as a result of MRH increases from a probability of around 0.2-0.4. This is also the case for the number of medicines.ConclusionsFrailty is associated with MRH, independent of polypharmacy. Reducing the burden of frailty through an integrated health and social care approach, alongside strategies to reduce inappropriate polypharmacy, may reduce MRH related healthcare utilisation.
KW - Aged
KW - Frailty
KW - Risk stratification
KW - Adverse drug reactions
KW - Older People
KW - Non-adherence
KW - Humans
KW - Polypharmacy
KW - Patient Discharge
KW - Cohort Studies
KW - Prospective Studies
KW - Aged, 80 and over
UR - http://www.scopus.com/inward/record.url?scp=85127273357&partnerID=8YFLogxK
U2 - 10.1093/ageing/afac054
DO - 10.1093/ageing/afac054
M3 - Article
SN - 0002-0729
VL - 51
JO - Age and Ageing
JF - Age and Ageing
IS - 3
M1 - afac054
ER -