Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3035 — The Quality of Pharmacotherapy among Older Veterans Discharged from the Emergency Department

Hastings SN (GRECC, Durham VAMC ) , Schmader KE (GRECC, Durham VAMC), Sloane RJ (Duke Center for the Study of Aging and Human Development), Goldberg KC (Center for Health Services Research in Primary Care, Durham VAMC), Oddone EZ (Center for Health Services Research in Primary Care, Durham VAMC)

Objectives:
Pharmacotherapy is an important health service provided to older veterans who are discharged from the ED, yet older patients are at significant risk for adverse events following medication changes. The objectives of this study were: 1) to determine the prevalence and type of suboptimal pharmacotherapy among older veterans discharged from the ED and 2) to examine factors associated with suboptimal pharmacotherapy in this population.

Methods:
We performed a retrospective cohort study at an academic Veterans’ Affairs (VA) medical center. The sample included 421 veterans aged 65 and older who were prescribed a new medication at the time of discharge from the ED. The primary dependent variable, suboptimal pharmacotherapy, was a composite measure defined as one or more drug-related problems based on: 1) drugs-to-avoid criteria, 2) drug-drug interactions, 3) drug-disease interactions, or 4) 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 (mean 1.65 +/- 1.1/patient). The most frequently prescribed medications were non-steroidal anti-inflammatory drugs (NSAIDs) (N=59), opioid analgesics (N=47), and fluoroquinolone antibiotics (N=46). Overall, 166 (39.4%) of subjects were found to have suboptimal pharmacotherapy with regard to their discharge medications; 49 (11.6%) were prescribed a drug to avoid, 109 (25.9%) 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 (59.5% of these evaluated prescribing and 40.5% evaluated medication monitoring). No consistent associations between patient or visit characteristics and suboptimal pharmacotherapy were identified in multivariable models.

Implications:
More than 1/3 of older veterans prescribed a new medication when discharged from the ED were found to have suboptimal prescribing or inadequate medication monitoring.

Impacts:
A substantial number of older veterans discharged from the ED may be at risk for adverse events due to suboptimal prescribing and inadequate medication monitoring. Further study is needed to develop interventions to improve the quality of pharmacotherapy in this vulnerable population.