title: Characteristics associated with postdischarge medication errors.
abstract: OBJECTIVE
  To examine the association of patient- and medication-related factors with postdischarge medication errors.
  
  
  METHODS
  The Vanderbilt Inpatient Cohort Study includes adults hospitalized with acute coronary syndromes and/or acute decompensated heart failure. We measured health literacy, subjective numeracy, marital status, cognition, social support, educational attainment, income, depression, global health status, and medication adherence in patients enrolled from October 1, 2011, through August 31, 2012. We used binomial logistic regression to determine predictors of discordance between the discharge medication list and the patient-reported list during postdischarge medication review.
  
  
  RESULTS
  Among 471 patients (mean age, 59 years), the mean total number of medications reported was 12, and 79 patients (16.8%) had inadequate or marginal health literacy. A total of 242 patients (51.4%) were taking 1 or more discordant medication (ie, appeared on either the discharge list or patient-reported list but not both), 129 (27.4%) failed to report a medication on their discharge list, and 168 (35.7%) reported a medication not on their discharge list. In addition, 279 participants (59.2%) had a misunderstanding in indication, dose, or frequency in a cardiac medication. In multivariable analyses, higher subjective numeracy (odds ratio [OR], 0.81; 95% CI, 0.67-0.98) was associated with lower odds of having discordant medications. For cardiac medications, participants with higher health literacy (OR, 0.84; 95% CI, 0.74-0.95), with higher subjective numeracy (OR, 0.77; 95% CI, 0.63-0.95), and who were female (OR, 0.60; 95% CI, 0.46-0.78) had lower odds of misunderstandings in indication, dose, or frequency.
  
  
  CONCLUSIONS
  Medication errors are present in approximately half of patients after hospital discharge and are more common among patients with lower numeracy or health literacy.
authors.affiliation: Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center, Nashville, Tennessee; Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee; Center for Health Services Research, Vanderbilt University, Nashville, Tennessee. Electronic address: Amanda.S.Mixon@Vanderbilt.edu.
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Mixon
authors.affiliation: Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Amy P
authors.initials: AP
authors.lastname: Myers
authors.affiliation: Center for Health Services Research, Vanderbilt University, Nashville, Tennessee.
authors.forename: Cardella L
authors.initials: CL
authors.lastname: Leak
authors.affiliation: Center for Health Services Research, Vanderbilt University, Nashville, Tennessee; Center for Quality Aging, Vanderbilt University, Nashville, Tennessee.
authors.forename: J Mary
authors.initials: JM
authors.lastname: Lou Jacobsen
authors.affiliation: Center for Health Services Research, Vanderbilt University, Nashville, Tennessee.
authors.forename: Courtney
authors.initials: C
authors.lastname: Cawthon
authors.affiliation: Center for Health Services Research, Vanderbilt University, Nashville, Tennessee.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Goggins
authors.affiliation: Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.
authors.forename: Samuel
authors.initials: S
authors.lastname: Nwosu
authors.affiliation: Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Schildcrout
authors.affiliation: Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center, Nashville, Tennessee; Center for Quality Aging, Vanderbilt University, Nashville, Tennessee.
authors.forename: John F
authors.initials: JF
authors.lastname: Schnelle
authors.affiliation: Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center, Nashville, Tennessee; Center for Health Services Research, Vanderbilt University, Nashville, Tennessee; Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.
authors.forename: Theodore
authors.initials: T
authors.lastname: Speroff
authors.affiliation: Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee; Center for Health Services Research, Vanderbilt University, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, Tennessee.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000523:psychology; D003072:Cognition Disorders; D003863:Depression; D005260:Female; D057220:Health Literacy / Q000592:standards*; D006333:Heart Failure / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D055118:Medication Adherence / Q000523:psychology; D008508:Medication Errors / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards*; D011446:Prospective Studies; D012944:Social Support; D016903:Drug Monitoring