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OBJECTIVES: To determine the prevalence and type of suboptimal pharmacotherapy that older veterans discharged from the emergency department (ED) or urgent care clinic (UCC) receive and to examine factors associated with suboptimal pharmacotherapy in this population. DESIGN: Retrospective, cohort study. SETTING: An academically affiliated Department of Veterans' Affairs (VA) Medical Center. PARTICIPANTS: Four hundred twenty-one veterans aged 65 and older who were prescribed a new medication at the time of discharge from the ED or UCC. MEASUREMENTS: The primary dependent variable, suboptimal pharmacotherapy, was a composite measure defined as one or more drug-related problems, based on drugs-to-avoid criteria, drug–drug interactions, drug–disease interactions, and 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 or UCC (mean number±standard deviation per patient 1.65±1.1). The most frequently prescribed medications were nonsteroidal antiinflammatory drugs (n=59), opioid analgesics (n=47), and fluoroquinolone antibiotics (n=46). Overall, 134 (31.8%) subjects were found to have suboptimal pharmacotherapy with regard to their discharge medications; 49 (11.6%) were prescribed a drug to avoid, 53 (12.6%) 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 (61% of these evaluated prescribing and 39% evaluated medication monitoring). No consistent associations between patient or visit characteristics and suboptimal pharmacotherapy were identified in multivariable models. CONCLUSION: A substantial number of older adults discharged from the ED or UCC may be at risk for adverse events due to suboptimal prescribing and inadequate medication monitoring. Further study is needed to examine the relationship between suboptimal pharmacotherapy and adverse clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: An Emergency Department (ED) visit represents a time of significant risk for an older adult; however, little is known about adverse outcomes after an ED visit in the VA system.Objectives: 1) To describe the frequency and type of adverse health outcomes among older veterans discharged from the ED, and 2) To determine risk factors associated with adverse outcomes.Design: Retrospective, cohort study at an academically affiliated VA medical center.Patients: A total of 942 veterans > or = 65 years old discharged from the ED.Measurements and Main Results: Primary dependent variable was adverse outcome, defined as a repeat VA ED visit, hospitalization, and/or death within 90 days. Overall, 320 (34.0%) patients experienced an adverse outcome: 245 (26%) returned to the VA ED but were not admitted, 125 (13.3%) were hospitalized, and 23 (2.4%) died. In adjusted analyses, higher score on the Charlson Comorbidity Index (hazard ratio [HR] 1.11; 95% CI 1.03, 1.21), ED visit within the previous 6 months (HR 1.64; 95% CI 1.30, 2.06), hospitalization within the previous 6 months (HR 1.70, 95% CI 1.30, 2.22), and triage to the emergency unit (compared to urgent care clinic) (HR 1.76, 95% CI 1.32, 2.36) were independently associated with higher risk of adverse outcomes.Conclusion: More than 1 in 3 older veterans discharged from the ED experienced a significant adverse outcome within 90 days of ED discharge. Identifying veterans at greatest risk for adverse outcomes after ED discharge can inform the design and targeting of interventions to reduce morbidity and costs in this group. [ABSTRACT FROM AUTHOR]

To determine the prevalence and predictors of unnecessary drug use at hospital discharge in frail elderly patients. Cross-sectional. Eleven Veterans Affairs Medical Centers. Three hundred eighty-four frail older patients from the Geriatric Evaluation and Management Drug Study. Assessment of unnecessary drug use was determined by the consensus of a clinical pharmacist and physician pair applying the Medication Appropriateness Index to each regularly scheduled medication at hospital discharge. Those drugs that received an inappropriate rating for indication, efficacy, or therapeutic duplication were defined as unnecessary. Forty-four percent of patients had at least one unnecessary drug, with the most common reason being lack of indication. The most commonly prescribed unnecessary drug classes were gastrointestinal, central nervous system, and therapeutic nutrients/minerals. Factors associated ( P<.05) with unnecessary drug use included hypertension (adjusted odds ratio (AOR)=0.61, 95% confidence interval (CI)=0.38–0.96), multiple prescribers (AOR=3.35, 95% CI=1.16–9.68), and nine or more medications (AOR=2.24, 95% CI=1.25–3.99). A high prevalence of unnecessary drug use at discharge was found in frail hospitalized elderly patients. Additional studies are needed to identify predictors and prevalence of unnecessary drug use in nonveteran populations so that interventions can be designed to reduce the problem. [ABSTRACT FROM AUTHOR]