Date: 11 June 2018
The results of the PRIME study, which investigated the burden of medication-related harm (MRH) in older patients following hospital discharge, has been published in the British Journal of Clinical Pharmacology.
Polypharmacy, the use of multiple medications by a patient, is increasingly common in older adults, placing them at risk of MRH. MRH includes adverse drug reactions (ADRs), medication errors and inappropriate use or underuse of medicines. Patients are particularly vulnerable to problems with their medications in the period following hospital discharge due to medication changes and poor information transfer between hospital and primary care. This transition period has not been extensively explored and so the PRIME study aimed to investigate the incidence, severity, preventability and cost of MRH in older adults following their discharge from hospital.
The PRIME study found that more than one in three patients experienced harm from their medicines within two months of hospital discharge, and that this was potentially preventable in half of the cases. MRH was most commonly found to occur from the toxicity of the medicine itself and in a quarter of cases from poor adherence.
The study found there was a substantial use of NHS services attributable to the MRH. Four out of every five patients who experienced harm then used NHS services, and 8% of patients were readmitted to hospital as a consequence. Based on these results, the estimated cost to the NHS in England is £396 million annually.
Senior pharmacists interviewed patients and carers, reviewed GP records and analysed hospital readmissions to determine medication-related harm. All cases were then scrutinised by an expert committee of senior geriatricians and pharmacists.
The medicines found to pose the highest risk were opiates, antibiotics and benzodiazepines. Patients suffered a range of conditions including serious kidney injury, psychological disturbance, irregular heart rhythms, confusion, dizziness, falls, diarrhoea, constipation and bleeding.
The study was led by Brighton and Sussex Medical School (BSMS) and King’s College, London. It was funded by the National Institute for Health Research (NIHR) Research for Patients Benefit Scheme which funds topics and research methodologies that increase the effectiveness of NHS services, provide value for money and benefit patients.
The study took place at five sites in south England, including Brighton and Sussex University Hospitals NHS Trust and Western Sussex Hospitals NHS Foundation Trust. 1,280 patients with an average age of 82 years were recruited.
Professor Chakravarthi Rajkumar, Chair of Geriatrics and Stroke Medicine at BSMS, and Clinical Research lead for NIHR Clinical Research Network Kent, Surrey and Sussex said: “As the use of medicines in the ageing population is rapidly increasing, it is vital that we improve awareness among clinicians of the harm that medicines commonly cause. The risk-to-benefit analysis is particularly complex in the older population. Once medicine is initiated, there should be a tentative stop date, monitoring of correct usage and vigilance for adverse reactions.
“When a patient is due for surgery, full informed consent is taken after the risks and benefits are clearly discussed. Medication-related harm can be life-threatening and similarly decisions to prescribe high-risk medicines should be taken after a comprehensive discussion with the patient. While the cost implications are significant, the magnitude extends beyond finances to adversely affect the quality of life for patients and families.”
Dr Khalid Ali, Senior Lecturer in Geriatrics at BSMS and Research Lead for Aging for NIHR Clinical Research Network Kent, Surrey and Sussex was Chief Investigator of the study, added: “Supporting health literacy within the older population, specifically in terms of medication usage, is crucial. There is also an increasing volume of work on the potential benefits of ‘deprescribing’ medicines in older adults, whereby medications are reduced safely in a way that is acceptable to patients.”
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