1054 — Association between High-Risk Medication in the Elderly and Drug-Disease Interactions with Use of Emergency/Hospital Care and Mortality
Pugh MJ, Downs JR, and Noel PH, VERDICT; Berlowitz DR, CHQOER; Marcum ZA, University of Pittsburgh; Hanlon JT, CHERP;
The Institute of Medicine identified recognition and prevention of drug-related problems in the elderly as principal patient safety issues for this decade. While measures of inappropriate prescribing have been available for over a decade, in 2006 the National Committee on Quality Assurance (NCQA) created two measures to examine quality of prescribing for older patients based on existing consensus-based measures. The first was a list of High Risk Medications in the Elderly (HRME), and the second included clinically relevant drug-disease interactions (Rx-DIS). Our objective was to assess the association between incident HRME and Rx-DIS exposure and emergency room (ER)/hospital care or mortality as a validation of these quality measures.
This retrospective VA database study identified incident exposure to HRME and Rx-DIS drugs in FY06 using VA pharmacy data, and outcomes for 12 months following exposure using VA outpatient, inpatient, and vital status files. HRME analyses included Veterans who were >=65 years of age in FY06 and who received VA care between FY04-06; the Rx-DIS subsample included those with a history of falls/hip fracture, chronic renal failure, and/or dementia. Hierarchical logistic regression models examined the association between exposure and outcomes controlling for demographic characteristics (age, sex, race), chronic disease states, and indicators of disease burden the previous year (e.g., number of prescriptions, ER/hospital care).
Among the 1,780,787 Veterans who met inclusion criteria, 80,475 had incident HRME exposure (4.5%). The Rx-DIS sample included 305,041, of whom 3.2% (N = 9,761) had incident exposure. Multivariable analyses found that HRME was significantly associated with ER/hospital care (2.69, [2.64-2.74]) and mortality (1.60, [1.54-1.67]). Similar statistically significant results were found for Rx-DIS exposure with ER/hospital care (1.08, [1.01-1.16]) and mortality (1.61, [1.52-1.71]).
Analyses support the link between HRME/Rx-DIS exposure and clinically significant outcomes.
Safe and effective medication prescribing is a cornerstone to Veteran-centered care. Given that total exposure (including prevalent exposure) to drugs included in these measures is over 25% of older Veterans, research incorporating structured geriatric education and/or pharmacy interventions within the VA may be used to enhance safe and effective medication prescription for Veterans.