Medication Regimen Complexity and Hospital Readmission in Older Adults With Chronic Kidney Disease

Wubshet H Tesfaye, Gregory M Peterson, Ronald L Castelino, Charlotte McKercher, Matthew D Jose, Barbara C Wimmer, Syed Tabish R Zaidi

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

BACKGROUND: Chronic kidney disease (CKD) is characterized by high rates of hospital admissions and readmissions. However, there is a scarcity of research into medication-related factors predicting such outcomes in this patient group.

OBJECTIVE: To evaluate the effect of medication regimen complexity at hospital discharge on subsequent readmissions and their timing in older adults with CKD.

METHODS: This was a 12-month retrospective cohort study of 204 older (⩾65 years) CKD patients in an Australian tertiary care hospital. Medication regimen complexity was quantified using the 65-item medication regimen complexity index (MRCI). The outcomes were the occurrence of readmission in 30 days and time to readmission within 12 months. Logistic regression was used to identify factors predicting 30-day readmission, and a competing risks proportional subdistribution hazard model, accounting for deaths, was used for factors predicting time to readmission.

RESULTS: Overall, 50 (24%) patients, predominantly men (72%), were readmitted within 30 days of follow-up. MRCI was not significantly associated with 30-day readmission (odds ratio [OR] = 1.27; 95% CI = 0.94-1.73). The median (interquartile range) time to readmission within 12 months was 145 (31-365) days. On a multivariate analysis, a 10-unit increase in MRCI was associated with a shorter time to readmission within 12 months (subdistribution HR = 1.18; 95% CI = 1.01-1.36). Conclusion and Relevance: Medication regimen complexity was not significantly associated with 30-day readmission; however, it was associated with a significantly shorter time to 12-month readmission in older CKD patients. This finding highlights the importance of medication regimen complexity as a potential target for medical interventions to reduce readmission risks.

Original languageEnglish
Pages (from-to)28-34
Number of pages7
JournalDICP, Annals of Pharmacotherapy
Volume53
Issue number1
DOIs
Publication statusPublished - Jan 2019
Externally publishedYes

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Patient Readmission
Chronic Renal Insufficiency
Tertiary Healthcare
Proportional Hazards Models
Tertiary Care Centers
Cohort Studies
Multivariate Analysis
Retrospective Studies
Logistic Models
Odds Ratio
Research

Cite this

Tesfaye, W. H., Peterson, G. M., Castelino, R. L., McKercher, C., Jose, M. D., Wimmer, B. C., & Zaidi, S. T. R. (2019). Medication Regimen Complexity and Hospital Readmission in Older Adults With Chronic Kidney Disease. DICP, Annals of Pharmacotherapy, 53(1), 28-34. https://doi.org/10.1177/1060028018793419
Tesfaye, Wubshet H ; Peterson, Gregory M ; Castelino, Ronald L ; McKercher, Charlotte ; Jose, Matthew D ; Wimmer, Barbara C ; Zaidi, Syed Tabish R. / Medication Regimen Complexity and Hospital Readmission in Older Adults With Chronic Kidney Disease. In: DICP, Annals of Pharmacotherapy. 2019 ; Vol. 53, No. 1. pp. 28-34.
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Medication Regimen Complexity and Hospital Readmission in Older Adults With Chronic Kidney Disease. / Tesfaye, Wubshet H; Peterson, Gregory M; Castelino, Ronald L; McKercher, Charlotte; Jose, Matthew D; Wimmer, Barbara C; Zaidi, Syed Tabish R.

In: DICP, Annals of Pharmacotherapy, Vol. 53, No. 1, 01.2019, p. 28-34.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Medication Regimen Complexity and Hospital Readmission in Older Adults With Chronic Kidney Disease

AU - Tesfaye, Wubshet H

AU - Peterson, Gregory M

AU - Castelino, Ronald L

AU - McKercher, Charlotte

AU - Jose, Matthew D

AU - Wimmer, Barbara C

AU - Zaidi, Syed Tabish R

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N2 - BACKGROUND: Chronic kidney disease (CKD) is characterized by high rates of hospital admissions and readmissions. However, there is a scarcity of research into medication-related factors predicting such outcomes in this patient group.OBJECTIVE: To evaluate the effect of medication regimen complexity at hospital discharge on subsequent readmissions and their timing in older adults with CKD.METHODS: This was a 12-month retrospective cohort study of 204 older (⩾65 years) CKD patients in an Australian tertiary care hospital. Medication regimen complexity was quantified using the 65-item medication regimen complexity index (MRCI). The outcomes were the occurrence of readmission in 30 days and time to readmission within 12 months. Logistic regression was used to identify factors predicting 30-day readmission, and a competing risks proportional subdistribution hazard model, accounting for deaths, was used for factors predicting time to readmission.RESULTS: Overall, 50 (24%) patients, predominantly men (72%), were readmitted within 30 days of follow-up. MRCI was not significantly associated with 30-day readmission (odds ratio [OR] = 1.27; 95% CI = 0.94-1.73). The median (interquartile range) time to readmission within 12 months was 145 (31-365) days. On a multivariate analysis, a 10-unit increase in MRCI was associated with a shorter time to readmission within 12 months (subdistribution HR = 1.18; 95% CI = 1.01-1.36). Conclusion and Relevance: Medication regimen complexity was not significantly associated with 30-day readmission; however, it was associated with a significantly shorter time to 12-month readmission in older CKD patients. This finding highlights the importance of medication regimen complexity as a potential target for medical interventions to reduce readmission risks.

AB - BACKGROUND: Chronic kidney disease (CKD) is characterized by high rates of hospital admissions and readmissions. However, there is a scarcity of research into medication-related factors predicting such outcomes in this patient group.OBJECTIVE: To evaluate the effect of medication regimen complexity at hospital discharge on subsequent readmissions and their timing in older adults with CKD.METHODS: This was a 12-month retrospective cohort study of 204 older (⩾65 years) CKD patients in an Australian tertiary care hospital. Medication regimen complexity was quantified using the 65-item medication regimen complexity index (MRCI). The outcomes were the occurrence of readmission in 30 days and time to readmission within 12 months. Logistic regression was used to identify factors predicting 30-day readmission, and a competing risks proportional subdistribution hazard model, accounting for deaths, was used for factors predicting time to readmission.RESULTS: Overall, 50 (24%) patients, predominantly men (72%), were readmitted within 30 days of follow-up. MRCI was not significantly associated with 30-day readmission (odds ratio [OR] = 1.27; 95% CI = 0.94-1.73). The median (interquartile range) time to readmission within 12 months was 145 (31-365) days. On a multivariate analysis, a 10-unit increase in MRCI was associated with a shorter time to readmission within 12 months (subdistribution HR = 1.18; 95% CI = 1.01-1.36). Conclusion and Relevance: Medication regimen complexity was not significantly associated with 30-day readmission; however, it was associated with a significantly shorter time to 12-month readmission in older CKD patients. This finding highlights the importance of medication regimen complexity as a potential target for medical interventions to reduce readmission risks.

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KW - Clinical Protocols/standards

KW - Female

KW - Hospitalization

KW - Humans

KW - Male

KW - Patient Readmission/statistics & numerical data

KW - Renal Insufficiency, Chronic/therapy

KW - Retrospective Studies

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DO - 10.1177/1060028018793419

M3 - Review article

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JO - DICP, Annals of Pharmacotherapy

JF - DICP, Annals of Pharmacotherapy

SN - 1060-0280

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