Adverse drug events are a primary cause of hospitalization in the elderly. Nearly
70% of the $177.4 billion dollars spent on drug related morbidity and mortality in the
U.S. is due to hospitalizations. Polypharmacy, inappropriate medications or medication
regimen complexity have all been implicated as precursors to adverse drug events and
as indicators of high risk medication regimens. Understanding the relationship between
medication regimens and readmission is important when evaluating potential errors in
administration, risk-benefit ratios, and readmission risk. However, due to definitional
and measurement issues, the high risk medication regimen remains an elusive concept.
This study characterizes medication regimens, defines high risk medication
regimens, and determines if high risk medication regimens predict re-hospitalization in
home healthcare clients over age 65. An exploratory, secondary analysis of OASIS data
and medication records from 15 home care agencies was used to characterize
medication use in 911 older adults discharged from the hospital to their first episode of
home care in 2004. Conceptual and operational definitions of polypharmacy, potentially
inappropriate medications, medication regimen complexity, and high risk medication
regimens were developed. Logistic regression and structural equation modeling were
used to examine the relationship between comorbidity, a variety of risk factors
supported by the literature, high risk medication regimens (defined by polypharmacy, potentially inappropriate medication regimens, and medication regimen complexity)
and re-hospitalization to determine if high risk medication regimens predicted rehospitalization
in these subjects. Factor analysis revealed that high risk medication regimens are composed of
polypharmacy, potentially inappropriate medication regimens, and medication regimen
complexity, and that a model using this concept rather than individual medication
variables proved to be the most predictive and parsimonious model. The model
accounted for 10% of variance in re-hospitalization in this sample. Additionally, high
risk medication regimens appear to have as much influence as comorbidity on hospital
Future research should include high risk medication regimens as a predictor of
readmission and previously completed studies may need to be re-evaluated in light of
these findings. Both the findings and the methodology will be useful in examining
predictive potential of high risk medications regimens in other settings.
University of Minnesota Ph.D. dissertation. October 2010. Major: Nursing. Advisors: Christine Mueller, Bonnie Westra. i computer file (PDF); xii, 337 pages, appendices A-D.
Dierich, Mary Therese Jancaric.
High risk medication regimens and medication related predictors of hospital readmission in elderly home care patients..
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