Quality of pharmacotherapy and outcomes for older veterans discharged from the emergency department.
OBJECTIVE
To determine whether suboptimal pharmacotherapy increases the risk of adverse outcomes in older adults discharged from the emergency department (ED).


METHODS
Retrospective, cohort study.


METHODS
Academically affiliated Veterans Affairs Medical Center.


METHODS
Nine hundred forty-two veterans aged 65 and older discharged from the ED.


METHODS
The primary independent variable, suboptimal pharmacotherapy, was based on drugs-to-avoid criteria, drug-drug interactions, drug-disease interactions, or failure to satisfy explicit quality indicators (QIs). An adverse outcome was defined as one or more repeat ED visits or hospitalizations or death within 90 days of ED discharge.


RESULTS
Four hundred twenty-one patients were prescribed a new medication at ED discharge. Of these, 134 (31.8%) had suboptimal pharmacotherapy; 49 (11.6%) were prescribed a drug to avoid, 53 (12.6%) received a drug that introduced a new drug-drug interaction, 24 (5.7%) were given a drug that introduced a drug-disease interaction, and 74 (17.6%) did not have a QI satisfied. Overall, 320 patients (34.0%) experienced an adverse outcome within 90 days. Multivariable analyses suggested a trend toward greater risk of adverse outcomes in patients with suboptimal pharmacotherapy (hazard ratio=1.32, 95% confidence interval=0.95, 1.84).


CONCLUSIONS
A substantial number of older male veterans discharged from the ED may be at risk for adverse events due to suboptimal prescribing and inadequate medication monitoring. Efforts to improve the quality of pharmacotherapy in this vulnerable population are warranted.
Hastings
S Nicole
SN
Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina, USA. hasti003@mc.duke.edu
Schmader
Kenneth E
KE
Sloane
Richard J
RJ
Weinberger
Morris
M
Pieper
Carl F
CF
Goldberg
Kenneth C
KC
Oddone
Eugene Z
EZ
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004347:Drug Interactions; D016903:Drug Monitoring / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006785:Hospitals, University; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009657:North Carolina; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012306:Risk; D014728:Veterans / Q000706:statistics & numerical data*