Objective: To determine whether potentially inappropriate medications (PIMs) prescribed in the emergency department (ED) are associated with increased ED revisits in older adults.
Methods: A retrospective chart review of adults 65 years and older, discharged from an ED (January 2012–November 2015) with any PIM prescription versus no-PIM prescription. PIMs were defined using Beers 2015 guidelines. Primary outcomes were ED revisits within 3- and 30-days from index ED discharge, calculated as % proportions and odds ratios. Age, gender, race/ethnicity, polypharmacy, and comorbidity were analyzed as independent predictors of ED returns.
Results: Of 10,830 patients 65+ discharged from the ED with a prescription, 2,135 (19.71%) received one or more PIMs. Mean age was 75.90 years; 63% were females; 30.25% were white, 22.81% were black, 1.01% were Hispanic, and 45.94% were other. 12.37% of ED revisits in 30 days were associated with PIMs, versus 17.30% from no-PIMs (P < .0001). In 3 days, 2.95% of the PIMs group had revisits, compared with 5.04% in the no-PIMs group (P < .0001). Predictors of ED revisits in 30-days were age 75 years and older (P < .001) and being male (P = 0.02), race/ethnicity (P < .0001 for Black, < .0001 for Hispanic and < .01 for Other). Polypharmacy (use of 2 or more medications) increased the odds of receiving a PIM (P < .0001).
Of the above patients, 7,423 were Medicare beneficiaries. Of these, 65% were female; 34.18% were white, 22.55% were Black, less than 1% were Hispanic, and 42.55% were other. Mean age was 76.30 years, and 17.80% received at least one PIM, 48% with Charlson Comorbidity Index (CCI) >1. ED revisits (at the index or any hospital) in 30 days were 17.70% for PIMs and 23.16% for no-PIMs (P < .001); In 3 days, 4.14% for PIMs versus 4.87% for no-PIMs (P 0.36). 27.39% of patients receiving PIMs had Charlson Comorbidity Index (CCI) scores of 1 or more (P < .0001), compared to 20.56% who received no PIMs (P < .0001). CCI score was not associated with ED revisit rate. Predictors of ED revisits in 30 days were PIMs (P < .001), older age (P < .01) and race /ethnicity (P < .001 for Hispanic and < .0001 for Other).
Conclusions: Patients discharged from the ED receiving PIMs had lower odds of revisiting the ED. Future studies are needed to understand this association and the implications of these findings.
|Commitee:||Doucette, John, Vargas-Torres, Carmen, Loo, George , Moskowitz, Alan, Gabrilove, Janice|
|School:||Icahn School of Medicine at Mount Sinai|
|School Location:||United States -- New York|
|Source:||MAI 81/4(E), Masters Abstracts International|
|Keywords:||Beers, Emergency, Medications, Older adults, PIM, Prescribing|
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