Outpatient medication use and health outcomes in post-acute coronary syndrome patients.
OBJECTIVE
To investigate the pattern of postdischarge evidence-based outpatient medication use and its impact on subsequent hospital readmissions in post-acute coronary syndrome (ACS) patients.


METHODS
Prospective observational study.


METHODS
A telephone survey was conducted to collect information from discharge to 8 months after discharge for 433 patients hospitalized with a primary diagnosis of ACS in 5 mid-Michigan hospitals. The survey data were then merged with chart review data from the initial hospitalization. We first conducted a longitudinal descriptive analysis of the utilization patterns of patient self-reported medication use from discharge to the 8-month survey. Then, multivariable logit analysis was used to estimate the effect of post-ACS medication use on self-reported hospital readmission at 3 months and 8 months after discharge. Propensity score matching was used to counter the possible bias induced by self-selection of outpatient medication use.


RESULTS
The pattern of outpatient medication use was dynamic. Most changes to medication regimens occurred within 3 months after discharge, with fewer changes in the subsequent 5 months. Taking a beta-blocker, angiotensin-converting enzyme inhibitor, or angiotension receptor blocker significantly reduced the probability of hospital readmission 3 months after discharge. Propensity score matching produced similar statistically significant results. Re-hospitalization within 3 months after discharge was a strong predictor of later hospital readmission up to 8 months.


CONCLUSIONS
Timely and appropriate medication adjustment in outpatient settings appears to be critically important to reduce hospital readmission among ACS patients.
Yang
Zhou
Z
Department of Health Services Research, Management and Policy, University of Florida, 101 S Newell Dr, Rm 4141, Gainesville, FL 32610-0195, USA. zyang@phhp.ufl.edu
Olomu
Ade
A
Corser
William
W
Rovner
David R
DR
Holmes-Rovner
Margaret
M
D000368:Aged; D000553:Ambulatory Care; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008485:Medical Audit; D008824:Michigan; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D011446:Prospective Studies