Abstract
ObjectiveTo evaluate the hypothesis that nonadherence to medication changes made at hospital discharge is associated with an increased risk of adverse events in the 30 days postdischarge.Study SettingPatients admitted to hospitals in Montreal, Quebec, between 2014 and 2016.Study DesignProspective cohort study.Data CollectionNonadherence to medication changes was measured by comparing medications dispensed in the community with those prescribed at hospital discharge. Patient, health system, and drug regimen‐level covariates were measured using medical services and pharmacy claims data as well as data abstracted from the patient's hospital chart. Multivariable Cox models were used to determine the association between nonadherence to medication changes and the risk of adverse events.Principal FindingsAmong 2655 patients who met our inclusion criteria, mean age was 69.5 years (SD 14.7) and 1581 (60%) were males. Almost half of patients (n = 1161, 44%) were nonadherent to at least one medication change, and 860 (32%) were readmitted to hospital, visited the emergency department, or died in the 30 days postdischarge. Patients who were not adherent to any of their medication changes had a 35% higher risk of adverse events compared to those who were adherent to all medication changes (1.41 vs 1.27 events/100 person‐days, adjusted hazard ratio: 1.35, 95% CI: 1.06‐1.71).ConclusionsAlmost half of all patients were not adherent to some or all changes made to their medications at hospital discharge. Nonadherence to all changes was associated with an increased risk of adverse events. Interventions addressing barriers to adherence should be considered moving forward.
Highlights
Hospitals have been organized to respond rapidly and efficiently to acute illness or injury
We found that almost half of patients were nonadherent to at least one medication change made at discharge in the 30 days posthospitalization
Whereas not filling any new medications was associated with an increased risk of adverse events, no increased risk was observed for nonadherence to discontinuations or dose changes
Summary
Hospitals have been organized to respond rapidly and efficiently to acute illness or injury. Institutions are increasingly managing high-risk, older patients who frequently require repeated admissions to hospital for exacerbations of their chronic conditions.[1] Approximately one third of multimorbid patients discharged from an acute care hospital are readmitted within 90 days, and each additional chronic condition independently increases the risk of such short-term readmissions.[2,3,4,5]. A number of studies have demonstrated that when older adults are hospitalized, they are often discharged on substantially different medication regimens than those at admission.[11,12,13] One might expect that discontinuations, additions, or modifications to patient drug regimens during hospitalization will reduce the likelihood of readmission in so far as patients follow these changes. The study was approved by the MUHC ethics committee (IRB #10180 GEN) as well as the Quebec Privacy Commissioner, and the trial was registered on clinical trials.gov (Registration # NCT01179867).[19]
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