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The quality of pharmacotherapy in older veterans discharged from the emergency department or urgent care clinic.
J Am Geriatr Soc. 2007 Sep; 55(9):1339-48.JA

Abstract

OBJECTIVES

To determine the prevalence and type of suboptimal pharmacotherapy that older veterans discharged from the emergency department (ED) or urgent care clinic (UCC) receive and to examine factors associated with suboptimal pharmacotherapy in this population.

DESIGN

Retrospective, cohort study.

SETTING

An academically affiliated Department of Veterans' Affairs (VA) Medical Center.

PARTICIPANTS

Four hundred twenty-one veterans aged 65 and older who were prescribed a new medication at the time of discharge from the ED or UCC.

MEASUREMENTS

The primary dependent variable, suboptimal pharmacotherapy, was a composite measure defined as one or more drug-related problems, based on drugs-to-avoid criteria, drug-drug interactions, drug-disease interactions, and failure to satisfy an explicit quality indicator for prescribing or medication monitoring.

RESULTS

A total of 757 drugs were prescribed to the 421 patients at the time of discharge from the ED or UCC (mean number+/-standard deviation per patient 1.65+/-1.1). The most frequently prescribed medications were nonsteroidal antiinflammatory drugs (n=59), opioid analgesics (n=47), and fluoroquinolone antibiotics (n=46). Overall, 134 (31.8%) subjects were found to have suboptimal pharmacotherapy with regard to their discharge medications; 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 quality indicator satisfied (61% of these evaluated prescribing and 39% evaluated medication monitoring). No consistent associations between patient or visit characteristics and suboptimal pharmacotherapy were identified in multivariable models.

CONCLUSION

A substantial number of older adults discharged from the ED or UCC may be at risk for adverse events due to suboptimal prescribing and inadequate medication monitoring. Further study is needed to examine the relationship between suboptimal pharmacotherapy and adverse clinical outcomes.

Authors+Show Affiliations

Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, North Carolina 27710, USA. hasti003@mc.duke.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

17767675

Citation

Hastings, S Nicole, et al. "The Quality of Pharmacotherapy in Older Veterans Discharged From the Emergency Department or Urgent Care Clinic." Journal of the American Geriatrics Society, vol. 55, no. 9, 2007, pp. 1339-48.
Hastings SN, Sloane RJ, Goldberg KC, et al. The quality of pharmacotherapy in older veterans discharged from the emergency department or urgent care clinic. J Am Geriatr Soc. 2007;55(9):1339-48.
Hastings, S. N., Sloane, R. J., Goldberg, K. C., Oddone, E. Z., & Schmader, K. E. (2007). The quality of pharmacotherapy in older veterans discharged from the emergency department or urgent care clinic. Journal of the American Geriatrics Society, 55(9), 1339-48.
Hastings SN, et al. The Quality of Pharmacotherapy in Older Veterans Discharged From the Emergency Department or Urgent Care Clinic. J Am Geriatr Soc. 2007;55(9):1339-48. PubMed PMID: 17767675.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The quality of pharmacotherapy in older veterans discharged from the emergency department or urgent care clinic. AU - Hastings,S Nicole, AU - Sloane,Richard J, AU - Goldberg,Kenneth C, AU - Oddone,Eugene Z, AU - Schmader,Kenneth E, PY - 2007/9/5/pubmed PY - 2007/10/19/medline PY - 2007/9/5/entrez SP - 1339 EP - 48 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 55 IS - 9 N2 - OBJECTIVES: To determine the prevalence and type of suboptimal pharmacotherapy that older veterans discharged from the emergency department (ED) or urgent care clinic (UCC) receive and to examine factors associated with suboptimal pharmacotherapy in this population. DESIGN: Retrospective, cohort study. SETTING: An academically affiliated Department of Veterans' Affairs (VA) Medical Center. PARTICIPANTS: Four hundred twenty-one veterans aged 65 and older who were prescribed a new medication at the time of discharge from the ED or UCC. MEASUREMENTS: The primary dependent variable, suboptimal pharmacotherapy, was a composite measure defined as one or more drug-related problems, based on drugs-to-avoid criteria, drug-drug interactions, drug-disease interactions, and failure to satisfy an explicit quality indicator for prescribing or medication monitoring. RESULTS: A total of 757 drugs were prescribed to the 421 patients at the time of discharge from the ED or UCC (mean number+/-standard deviation per patient 1.65+/-1.1). The most frequently prescribed medications were nonsteroidal antiinflammatory drugs (n=59), opioid analgesics (n=47), and fluoroquinolone antibiotics (n=46). Overall, 134 (31.8%) subjects were found to have suboptimal pharmacotherapy with regard to their discharge medications; 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 quality indicator satisfied (61% of these evaluated prescribing and 39% evaluated medication monitoring). No consistent associations between patient or visit characteristics and suboptimal pharmacotherapy were identified in multivariable models. CONCLUSION: A substantial number of older adults discharged from the ED or UCC may be at risk for adverse events due to suboptimal prescribing and inadequate medication monitoring. Further study is needed to examine the relationship between suboptimal pharmacotherapy and adverse clinical outcomes. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/17767675/The_quality_of_pharmacotherapy_in_older_veterans_discharged_from_the_emergency_department_or_urgent_care_clinic_ L2 - https://doi.org/10.1111/j.1532-5415.2007.01303.x DB - PRIME DP - Unbound Medicine ER -