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Medication-related harm in older adults following hospital discharge: development and validation of a prediction tool
  1. Nikesh Parekh1,
  2. Khalid Ali1,
  3. John Graham Davies2,
  4. Jennifer M Stevenson2,
  5. Winston Banya3,
  6. Stephen Nyangoma3,
  7. Rebekah Schiff4,
  8. Tischa van der Cammen5,
  9. Jatinder Harchowal6,
  10. Chakravarthi Rajkumar1
  1. 1 Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, UK
  2. 2 Institute of Pharmaceutical Science, King's College London, London, UK
  3. 3 Royal Brompton and Harefield NHS Foundation Trust, London, UK
  4. 4 Guy's and St Thomas' NHS Foundation Trust, London, UK
  5. 5 Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
  6. 6 Royal Marsden Hospital NHS Trust, London, UK
  1. Correspondence to Dr Nikesh Parekh, Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton BN1 9PX, UK; nikeshparekh{at}


Objectives To develop and validate a tool to predict the risk of an older adult experiencing medication-related harm (MRH) requiring healthcare use following hospital discharge.

Design, setting, participants Multicentre, prospective cohort study recruiting older adults (≥65 years) discharged from five UK teaching hospitals between 2013 and 2015.

Primary outcome measure Participants were followed up for 8 weeks in the community by senior pharmacists to identify MRH (adverse drug reactions, harm from non-adherence, harm from medication error). Three data sources provided MRH and healthcare use information: hospital readmissions, primary care use, participant telephone interview. Candidate variables for prognostic modelling were selected using two systematic reviews, the views of patients with MRH and an expert panel of clinicians. Multivariable logistic regression with backward elimination, based on the Akaike Information Criterion, was used to develop the PRIME tool. The tool was internally validated.

Results 1116 out of 1280 recruited participants completed follow-up (87%). Uncertain MRH cases (‘possible’ and ‘probable’) were excluded, leaving a tool derivation cohort of 818. 119 (15%) participants experienced ‘definite’ MRH requiring healthcare use and 699 participants did not. Modelling resulted in a prediction tool with eight variables measured at hospital discharge: age, gender, antiplatelet drug, sodium level, antidiabetic drug, past adverse drug reaction, number of medicines, living alone. The tool’s discrimination C-statistic was 0.69 (0.66 after validation) and showed good calibration. Decision curve analysis demonstrated the potential value of the tool to guide clinical decision making compared with alternative approaches.

Conclusions The PRIME tool could be used to identify older patients at high risk of MRH requiring healthcare use following hospital discharge. Prior to clinical use we recommend the tool’s evaluation in other settings.

  • Medication harm
  • older adults
  • healthcare use
  • hospital discharge
  • risk prediction

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  • Contributors CR, RS, JH, GD, JMS, KA and TvdC conceived of the PRIME study. KA, JH, GD and CR were co-applicants for the study grant. NP, CR, GD, JMS and KA designed this study. Data analysis was performed by NP, KA, GD and CR and statistical expertise was provided by WB and SN. All authors were involved in preparing the manuscript. All authors reviewed and approved the final manuscript.

  • Funding This research was funded by the National Institute for Health Research (PB-PG-0711-25094).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This research was approved by the National Research Ethics Service, East of England (REC Reference 13/EE/0075).

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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