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Community-acquired and hospital-acquired medication harm among older inpatients and impact of a state-wide medication management intervention
  1. Karen Pellegrin1,
  2. Alicia Lozano1,
  3. Jill Miyamura2,
  4. Joanne Lynn3,
  5. Les Krenk4,
  6. Sheena Jolson-Oakes4,
  7. Anita Ciarleglio1,
  8. Terry McInnis5,
  9. Alistair Bairos1,
  10. Lara Gomez1,
  11. Mercedes Benitez-McCrary6,
  12. Alexandra Hanlon7
  1. 1 Daniel K Inouye College of Pharmacy, University of Hawai`i at Hilo, Hilo, USA
  2. 2 Hawai`i Health Information Corporation, Honolulu, USA
  3. 3 Program to Improve Eldercare, Altarum, Washington DC, USA
  4. 4 Maui Clinic Pharmacy, Kahului, USA
  5. 5 Blue Thorn Inc, Cary, USA
  6. 6 Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, USA
  7. 7 School of Nursing, University of Pennsylvania, Philadelphia, USA
  1. Correspondence to Karen Pellegrin; karen3{at}hawaii.edu

Abstract

Background We previously reported reduction in the rate of hospitalisations with medication harm among older adults with our ‘Pharm2Pharm’ intervention, a pharmacist-led care transition and care coordination model focused on best practices in medication management. The objectives of the current study are to determine the extent to which medication harm among older inpatients is ‘community acquired’ versus ‘hospital acquired’ and to assess the effectiveness of the Pharm2Pharm model with each type.

Methods After a 3-year baseline, six non-federal general acute care hospitals with 50 or more beds in Hawaii implemented Pharm2Pharm sequentially. The other five such hospitals served as the comparison group. We measured frequencies and quarterly rates of admissions among those aged 65 and older with ‘community-acquired’ (International Classification of Diseases-coded as present on admission) and ‘hospital-acquired’ (coded as not present on admission) medication harm per 1000 admissions from 2010 to 2014.

Results There were 189 078 total admissions from 2010 through 2014, 7% of which had one or more medication harm codes. There were 16 225 medication harm codes, 70% of which were community-acquired, among these 13 795 admissions. The varied times when the intervention was implemented across hospitals were associated with a significant reduction in the rate of admissions with community-acquired medication harm compared with non-intervention hospitals (p=0.001), and specifically harm by anticoagulants (p<0.0001) and by medications in therapeutic use (p<0.001). The hospital-acquired medication harm rate did not change. The rate of admissions with community-acquired medication harm was reduced by 4.28 admissions per 1000 admissions per quarter in the Pharm2Pharm hospitals relative to the comparison hospitals.

Conclusion The Pharm2Pharm model is an effective way to address the growing problem of community-acquired medication harm among high-risk, chronically ill patients. This model demonstrates the importance of deploying specially trained pharmacists in the hospital and in the community to systematically identify and resolve drug therapy problems.

  • adverse events, epidemiology and detection
  • medication safety
  • pharmacists
  • quality measurement
  • transitions in care

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

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Footnotes

  • Contributors KP: model design and study concept, principal investigator of the CMS Health Care Innovation Award, drafting all sections of the manuscript except the statistics section. LK, SJ-O, AC: model design and launch. JL, TM, AB, LG, MB-M: model design. AL, AH: data analysis and interpretation, drafting the statistics section of the manuscript. JM: acquisition and interpretation of data. All authors reviewed the manuscript for critical content and editing.

  • Funding This project was supported by Funding Opportunity Number CMS-1C1-12-0001 from the Centers for Medicare and Medicaid Services, Center for Medicare and Medicaid Innovation. Its content is solely the responsibility of the authors and does not necessarily represent the official views of the HHS or any of its agencies.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval University of Hawaii.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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