The impact of including a medication review in an integrated care
pathway: a pilot study
Abstract
Objective: Our hypothesis was that the intervention would decrease (or
at least not increase) the number of potentially inappropriate
medications (PIMs) and the number of hospital readmissions within 30
days of discharge per hospital stay. Methods: A cohort of hospitalized
older adults enrolled in the PAERPA integrated care pathway (the exposed
cohort) was matched retrospectively with hospitalized older adults not
enrolled in the pathway (unexposed cohort) between January 1st, 2015,
and December 31st, 2018. It was an analysis of French health
administrative database. The inclusion criteria for exposed patients
were admission to an acute care department in general hospital, age 75
or over, at least three comorbidities or the prescription of diuretics
or oral anticoagulants, discharge alive, and performance of a medication
review. Results: For the study population (n=582), the mean ± standard
deviation age was 82.9 ± 4.9, and 190 (65.3%) were women. Depending on
the definition used, the overall median number of PIMs ranged from 2
[0;3] upon admission to 3 [0;3] at discharge. The intervention
was not associated with a significant difference in the mean number of
PIMs. Patients in the exposed cohort were half as likely to be
readmitted to hospital within 30 days of discharge, relative to patients
in the unexposed cohort. Conclusion: Our results show that a medication
review was not associated with a decrease in the mean number of PIMs.
However, the integrated care intervention including the medication
review was associated with a reduction in the number of hospital
readmissions at 30 days.