Risk factors for and preventability of drug-related hospital revisits in
older patients: a post-hoc analysis of a randomised clinical trial
Abstract
Aim: To identify older patients’ risk factors for drug-related
readmissions and assess the preventability of older patients’
drug-related revisits. Methods: Post-hoc analysis of a
randomised clinical trial with patients aged ≥ 65 years at eight wards
within four hospitals in Sweden. The primary outcome used to identify
risk factors was drug-related readmission within 12 months
post-discharge. A Cox proportional hazards model was made with
sociodemographic and clinical baseline characteristics. Four hundred
trial participants were randomly selected and their revisits (admissions
and emergency department visits) were assessed to identify potentially
preventable drug-related revisits, related diseases and causes.
Results: Among 2,637 patients (median age (interquartile range)
81 (74–87) years), 582 (22%) experienced a drug-related readmission
within 12 months. Sixteen risk factors (hazard ratio > 1, p
< 0.05) related to age, previous hospital visits, medication
use, multimorbidity and cardiovascular, liver, lung and peptic ulcer
disease were identified. The 400 patients experienced a total of 522
hospital revisits, of which 85 (16%) were potentially preventable
drug-related revisits. The two most prevalent diseases and causes
related to preventable revisits were heart failure (n=24, 28%) and
chronic obstructive pulmonary disease (n=13, 15%), and inadequate
treatment (n=23, 27%) and insufficient or no follow-up (n=22, 26%).
Conclusion: Risk factors for drug-related readmissions in older
hospitalised patients were age, previous hospital visits, medication use
and multiple diseases. Potentially preventable drug-related hospital
revisits are common and might be prevented through adequate medication
use and follow-up in older patients with cardiovascular or lung disease.