“An increasing number of older adults are using multiple medicines, and it is important that the benefits are outweighing the risks,” said Nikesh Parekh, MBBS, MPH, lead author of a recent study of a new predictive tool. The study was done in the context of the World Health Organization campaign to halve the incidence of medication-related harm (MRH) by 2022 – reducing MRH following hospital discharge was identified as a priority area.
This works allows clinicians to calculate the risk of a patient suffering MRH post-discharge requiring health care, said Dr. Parekh, a research fellow at Brighton and Sussex Medical School in Great Britain. “This enables practitioners and policy makers to target interventions to reduce MRH at those with highest risk. This should support the delivery of cost-effective care. The knowledge of individual risk can also prompt clinicians to reconsider any high-risk medicines that they intend on prescribing at discharge.”
This is the first prediction tool to calculate individual patient risk of serious MRH post-discharge, he added.The high readmission rate for older adults is often an avoidable pressure for hospitalists, particularly where MRH is the underlying cause. “The prediction tool has the potential to significantly reduce this burden for hospitalists/patients by identifying those individuals at high risk upon discharge and ensuring that monitoring and additional support is provided to them in the community with their medications,” Dr. Parekh said.
This electronic tool could be integrated into the electronic discharge summaries so that the information can be shared with primary care clinicians in a straightforward way. “The risk score should be calculated automatically by a self-population of the tool’s fields from information that exists on the patient within the electronic discharge system.”The tool now needs to be externally validated through testing in new settings to assess its validity and reliability in new populations. “If the tool is found to be usable by hospitalists and demonstrates reasonable predictive accuracy, then it should be implemented widely to reduce the incidence of MRH,” Dr. Parekh said.
1. Parekh N, et al. Medication-related harm in older adults following hospital discharge: development and validation of a prediction tool. BMJ Qual Saf. Published Online First 2019 Sept 16. doi: 10.1136/bmjqs-2019-009587.