Abstract
BACKGROUND: Hospitalized older adults are commonly discharged with changes to antihypertensive and glucose-lowering (cardiometabolic) medications. Though adverse drug events remain a leading cause of readmissions, there is little contemporary data on how medication discharge planning is communicated and how often medication errors occur post-discharge.
OBJECTIVE: To assess older adults' post-hospital medication use and ambulatory follow-up after receiving cardiometabolic medication changes during hospitalization.
DESIGN: Prospective cohort study from 11/2022 to 01/2024.
PARTICIPANTS: Adults aged 65 years or older from discharged home from an academic medical center with changes to pre-admission cardiometabolic medications.
MAIN MEASURES: Participants completed 7- and 90-day telephonic surveys on health status, medication use, and discharge planning. Self-report of medication use was compared to discharge summaries to identify medication errors (not initiating, not stopping, or taking incorrect dose). Multivariable regression models were used to identify characteristics associated with errors.
KEY RESULTS: The cohort included 151 participants (median [IQR] age 74 [70-78] years; 54% male; 17% Black, 82% White, 41% frail). Participants were admitted with a median (IQR) of 3 (2-4) cardiometabolic medications and discharged with a median (IQR) of 2 (1-4) medication changes. Of the 319 individual medications changed at discharge, 33% were further modified by 90 days. Participants reported comprehensive medication discharge planning for only 13% of medication changes. Though 93% of participants reported they understood the purpose of each of their medications at discharge, 39% had ≥ 1 medication errors at 7 days and 50% at 90 days. Use of ≥ 5 cardiometabolic medications was associated with higher rates of medication errors at 7 days (IRR 1.63; 95% CI 1.07-2.48) and 90 days (IRR 1.66; 95% CI 1.13-2.45).
CONCLUSIONS: Most hospitalized older adults discharged with cardiometabolic medication changes experienced medication errors or gaps in discharge planning. Steps to ensure all patients receive high-quality medication discharge planning are needed.