Dissertation/Thesis Abstract

Risk of Emergency Department (ED) Revisits in Older Adults Discharged with Potentially Inappropriate Medications: A Retrospective Cohort Study
by Hammouda, Nada Moustafa Sobhi, M.S., Icahn School of Medicine at Mount Sinai, 2019, 37; 22624348
Abstract (Summary)

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.

Indexing (document details)
Advisor: Hwang, Ula
Commitee: Doucette, John, Vargas-Torres, Carmen, Loo, George , Moskowitz, Alan, Gabrilove, Janice
School: Icahn School of Medicine at Mount Sinai
Department: Clinical Research
School Location: United States -- New York
Source: MAI 81/4(E), Masters Abstracts International
Subjects: Medicine, Aging
Keywords: Beers, Emergency, Medications, Older adults, PIM, Prescribing
Publication Number: 22624348
ISBN: 9781687980168
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