Potentially Harmful Medication Dispenses After a Fall or Hip Fracture : A Mixed Methods Study of a Commonly Used Quality Measure
Copyright © 2022 The Joint Commission. Published by Elsevier Inc. All rights reserved..
BACKGROUND: High-risk medication dispenses to patients with a prior fall or hip fracture represent a potentially dangerous disease-drug interaction among older adults. The research team quantified the prevalence, identified risk factors, and generated patient and provider insights into high-risk medication dispenses in a large, community-based integrated health system using a commonly used quality measure.
METHODS: This was a mixed methods study with a convergent design combining a retrospective cohort study using electronic health record (EHR) data, individual interviews of primary care physicians, and a focus group of patient advisors.
RESULTS: Of 113,809 patients ≥ 65 years with a fall/fracture in 2009-2015, 35.4% had a potentially harmful medication dispensed after their fall/fracture. Most medications were prescribed by primary care providers. Older age, male gender, and race/ethnicity other than non-Hispanic White were associated with a reduced risk of high-risk medication dispenses. Patients with a pre-fall/fracture medication dispense were substantially more likely to have a post-fall/fracture medication dispense (hazard ratio [HR] = 13.26, 95% confidence interval [CI] = 12.91-13.61). Both patients and providers noted that providers may be unaware of patient falls due to inconsistent assessments and patient reluctance to disclose falls. Providers also noted the lack of a standard location to document falls and limited decision support alerts within the EHR.
CONCLUSION: High-risk medication dispenses are common among older patients with a history of falls/fractures. Future interventions should explore improved assessment and documentation of falls, decision support, clinician training strategies, patient educational resources, building trusting patient-clinician relationships to facilitate long-term medication discontinuation among persistent medication users, and a focus on fall prevention.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:48 |
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| Enthalten in: |
Joint Commission journal on quality and patient safety - 48(2022), 4 vom: 18. Apr., Seite 222-232 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Fischer, Heidi [VerfasserIn] |
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| Anmerkungen: |
Date Completed 05.04.2022 Date Revised 19.06.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jcjq.2022.01.003 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM337220298 |
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| 520 | |a Copyright © 2022 The Joint Commission. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: High-risk medication dispenses to patients with a prior fall or hip fracture represent a potentially dangerous disease-drug interaction among older adults. The research team quantified the prevalence, identified risk factors, and generated patient and provider insights into high-risk medication dispenses in a large, community-based integrated health system using a commonly used quality measure | ||
| 520 | |a METHODS: This was a mixed methods study with a convergent design combining a retrospective cohort study using electronic health record (EHR) data, individual interviews of primary care physicians, and a focus group of patient advisors | ||
| 520 | |a RESULTS: Of 113,809 patients ≥ 65 years with a fall/fracture in 2009-2015, 35.4% had a potentially harmful medication dispensed after their fall/fracture. Most medications were prescribed by primary care providers. Older age, male gender, and race/ethnicity other than non-Hispanic White were associated with a reduced risk of high-risk medication dispenses. Patients with a pre-fall/fracture medication dispense were substantially more likely to have a post-fall/fracture medication dispense (hazard ratio [HR] = 13.26, 95% confidence interval [CI] = 12.91-13.61). Both patients and providers noted that providers may be unaware of patient falls due to inconsistent assessments and patient reluctance to disclose falls. Providers also noted the lack of a standard location to document falls and limited decision support alerts within the EHR | ||
| 520 | |a CONCLUSION: High-risk medication dispenses are common among older patients with a history of falls/fractures. Future interventions should explore improved assessment and documentation of falls, decision support, clinician training strategies, patient educational resources, building trusting patient-clinician relationships to facilitate long-term medication discontinuation among persistent medication users, and a focus on fall prevention | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Hahn, Erin E |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Bonnie H |e verfasserin |4 aut | |
| 700 | 1 | |a Munoz-Plaza, Corrine E |e verfasserin |4 aut | |
| 700 | 1 | |a Luong, Tiffany Q |e verfasserin |4 aut | |
| 700 | 1 | |a Harrison, Teresa N |e verfasserin |4 aut | |
| 700 | 1 | |a Slezak, Jeff M |e verfasserin |4 aut | |
| 700 | 1 | |a Sim, John J |e verfasserin |4 aut | |
| 700 | 1 | |a Mittman, Brian S |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Eric Anthony |e verfasserin |4 aut | |
| 700 | 1 | |a Singh, Hardeep |e verfasserin |4 aut | |
| 700 | 1 | |a Kanter, Michael H |e verfasserin |4 aut | |
| 700 | 1 | |a Reynolds, Kristi |e verfasserin |4 aut | |
| 700 | 1 | |a Danforth, Kim N |e verfasserin |4 aut | |
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