This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (48)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Quality of Care  • Quality of Care, Other  • Drug Therapy  • Medication Error  • Alert me on articles by topic  Social Bookmarking   What's this?

Prevalence and Contributing Factors

Eric A. Coleman, MD, MPH; Jodi D. Smith, ND; Devbani Raha, MS; Sung-joon Min, PhD

Arch Intern Med. 2005;165:1842-1847.

Background  Despite the national attention being given to the problem of medication safety, little attention has been paid to the medication problems that are encountered by older patients who are receiving care across settings. The objective of this study was to determine the prevalence and contributing factors associated with posthospital medication discrepancies.

Methods  The study population consisted of community-dwelling adults aged 65 years and older admitted to the hospital with 1 of 9 selected conditions (n = 375). A geriatric nurse practitioner performed a comprehensive medication assessment in the patient’s home within 24 to 72 hours after institutional discharge. The assessment focused on what older patients reported taking in comparison with the prehospital medication regimen and the posthospital medication regimen. Prevalence and types of medication discrepancies were categorized using the Medication Discrepancy Tool.

Results  A total of 14.1% of patients experienced 1 or more medication discrepancies. Using the Medication Discrepancy Tool, 50.8% of identified contributing factors for discrepancies were categorized as patient-associated, and 49.2% were categorized as system-associated. Five medication classes accounted for half of all medication discrepancies. Medication discrepancies were associated with the total number of medications taken and the presence of congestive heart failure. A total of 14.3% of the patients who experienced medication discrepancies were rehospitalized at 30 days compared with 6.1% of the patients who did not experience a discrepancy (P = .04).

Conclusions  A significant percentage of older patients experienced medication discrepancies after making the transition from hospital to home. Both patient-associated and system-associated solutions may be needed to ensure medication safety during this vulnerable period.

Author Affiliations: Division of Health Care Policy and Research, University of Colorado Health Sciences Center (Drs Coleman and Min), and Department of Continuing Care, Kaiser Permanente, Colorado Region (Dr Smith and Ms Raha), Denver.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Medication reconciliation at an academic medical center: Implementation of a comprehensive program from admission to discharge
Murphy et al.
Am J Health Syst Pharm 2009;66:2126-2131.
ABSTRACT | FULL TEXT  

Impact of a Pharmacist-Facilitated Hospital Discharge Program: A Quasi-Experimental Study
Walker et al.
Arch Intern Med 2009;169:2003-2010.
ABSTRACT | FULL TEXT  

Delayed Pediatric Office Follow-up of Newborns After Birth Hospitalization
Profit et al.
Pediatrics 2009;124:548-554.
ABSTRACT | FULL TEXT  

Medication Adherence: Its Importance in Cardiovascular Outcomes
Ho et al.
Circulation 2009;119:3028-3035.
ABSTRACT | FULL TEXT  

Effect of Medication Reconciliation With and Without Patient Counseling on the Number of Pharmaceutical Interventions Among Patients Discharged from the Hospital
Karapinar-Carkit et al.
The Annals of Pharmacotherapy 2009;43:1001-1010.
ABSTRACT | FULL TEXT  

Effect of an Electronic Medication Reconciliation Application and Process Redesign on Potential Adverse Drug Events: A Cluster-Randomized Trial
Schnipper et al.
Arch Intern Med 2009;169:771-780.
ABSTRACT | FULL TEXT  

From Hospital to Home: Assessing the Transitional Care Needs of Vulnerable Seniors
Graham et al.
The Gerontologist 2009;0:gnp005v1-gnp005.
ABSTRACT | FULL TEXT  

Prescribing discrepancies likely to cause adverse drug events after patient transfer
Boockvar et al.
Qual Saf Health Care 2009;18:32-36.
ABSTRACT | FULL TEXT  

Outcomes of a home telehealth intervention for patients with heart failure
Wakefield et al.
J Telemed Telecare 2009;15:46-50.
ABSTRACT | FULL TEXT  

Medication Reconciliation at Hospital Discharge: Evaluating Discrepancies
Wong et al.
The Annals of Pharmacotherapy 2008;42:1373-1379.
ABSTRACT | FULL TEXT  

Effectiveness of a medication discharge plan for transitions of care from hospital to outpatient settings
Lalonde et al.
Am J Health Syst Pharm 2008;65:1451-1457.
ABSTRACT | FULL TEXT  

Postdischarge Environmental and Socioeconomic Factors and the Likelihood of Early Hospital Readmission Among Community-Dwelling Medicare Beneficiaries
Arbaje et al.
The Gerontologist 2008;48:495-504.
ABSTRACT | FULL TEXT  

Collective Accountability for Medical Care -- Toward Bundled Medicare Payments
Hackbarth et al.
NEJM 2008;359:3-5.
FULL TEXT  

Association Between Hospitalization and Discontinuity of Medication Therapy Used in the Community Setting in the Netherlands
Stuffken et al.
The Annals of Pharmacotherapy 2008;42:933-939.
ABSTRACT | FULL TEXT  

Medication Use Among Inner-City Patients After Hospital Discharge: Patient-Reported Barriers and Solutions
Kripalani et al.
Mayo Clin Proc. 2008;83:529-535.
ABSTRACT | FULL TEXT  

Association of Early Follow-up After Acute Myocardial Infarction With Higher Rates of Medication Use
Daugherty et al.
Arch Intern Med 2008;168:485-491.
ABSTRACT | FULL TEXT  

Executive summary of the Continuity of Care in Medication Use Summit
Am J Health Syst Pharm 2008;65:e3-e9.
FULL TEXT  

Communication gaps and readmissions to hospital for patients aged 75 years and older: observational study
Witherington et al.
Qual Saf Health Care 2008;17:71-75.
ABSTRACT | FULL TEXT  

Patterns and Predictors of Early Hospital Readmission in Patients With Congestive Heart Failure
Hallerbach et al.
American Journal of Medical Quality 2008;23:18-23.
ABSTRACT  

Prevalence of Potential Medication Problems Among Dually Eligible Older Adults in Medicaid Waiver Services
Alkema et al.
The Annals of Pharmacotherapy 2007;41:1971-1978.
ABSTRACT | FULL TEXT  

Creating Accountable Care Organizations: The Extended Hospital Medical Staff
Fisher et al.
Health Aff (Millwood) 2007;26:w44-w57.
ABSTRACT | FULL TEXT  

Design and Implementation of an Application and Associated Services to Support Interdisciplinary Medication Reconciliation Efforts at an Integrated Healthcare Delivery Network
Poon et al.
J Am Med Inform Assoc 2006;13:581-592.
ABSTRACT | FULL TEXT  

The care transitions intervention: results of a randomized controlled trial.
Coleman et al.
Arch Intern Med 2006;166:1822-1828.
ABSTRACT | FULL TEXT