title: Drug-related readmissions to medical units of older adults discharged from acute geriatric units: results of the Optimization of Medication in AGEd multicenter randomized controlled trial.
abstract: OBJECTIVE
  To assess the effect of an intervention on drug-related problem (DRP; adverse drug reactions, adherence problems, underuse)-related readmission rates in older adults.
  
  
  METHODS
  Ancillary study from a 6-month, prospective, randomized, parallel-group, open-label trial.
  
  
  METHODS
  Six acute geriatric units in Paris and suburbs.
  
  
  METHODS
  Six hundred sixty-five consecutively admitted individuals were included: 317 in the intervention group (IG) and 348 in the control group (CG) (aged 86.1 ± 6.2, 66% female).
  
  
  METHODS
  Discharge-planning intervention combining chronic drug review, education, and enhanced transition-of-care communication.
  
  
  METHODS
  Chronic drugs at discharge of the two groups were compared. An expert committee blinded to group assignment adjudicated whether 6-month readmission to the study hospitals was related to drugs.
  
  
  RESULTS
  Six hundred thirty-nine individuals were discharged and followed up (300 IG, 339 CG). The intervention had no significant effect on drug regimen at discharge, characterized by prescriptions that are mostly appropriate but increase iatrogenic risk. Three hundred eleven readmissions occurred during follow-up (180 CG, 131 IG), of which 185 (59.5%) were adjudicated (102 CG, 83 IG). For 16, DRP imputability was doubtful. Of the remaining 169, DRPs were the most frequent cause for readmission, with 38 (40.4%) readmissions in the CG and 26 (34.7%) in the IG (relative risk reduction = 14.3%, 95% confidence interval = 14.0-14.5%, P = .54). The intervention was associated with 39.7% fewer readmissions related to adverse drug reactions (P = .12) despite the study's lack of power.
  
  
  CONCLUSIONS
  Drug-related problem prevention in older people discharged from the hospital should be a priority, with a focus on improving the monitoring of drugs with high iatrogenic risk.
authors.affiliation: Département d'Epidémiologie et de Recherche Clinique, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris, Paris, France. dombonnet@yahoo.fr
authors.forename: Dominique
authors.initials: D
authors.lastname: Bonnet-Zamponi
authors.forename: Lydie
authors.initials: L
authors.lastname: d'Arailh
authors.forename: Cécile
authors.initials: C
authors.lastname: Konrat
authors.forename: Sandrine
authors.initials: S
authors.lastname: Delpierre
authors.forename: Deborah
authors.initials: D
authors.lastname: Lieberherr
authors.forename: Aurélie
authors.initials: A
authors.lastname: Lemaire
authors.forename: Florence
authors.initials: F
authors.lastname: Tubach
authors.forename: Sophie
authors.initials: S
authors.lastname: Lacaille
authors.forename: Sylvie
authors.initials: S
authors.lastname: Legrain
mesh_terms: D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005500:Follow-Up Studies; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D059065:Medication Reconciliation / Q000379:methods; D010297:Paris; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies