Opioids Plus Peptic Ulcer Prescriptions: Red Flag at Discharge

Most hospitalized patients celebrate when attending physicians sign their discharge orders. The last thing they want is to spend another day in hospital, and they would also prefer to avoid rehospitalization.

Accrediting and certifying bodies are encouraging hospitals to improve the processes that contribute to rehospitalization, and many studies have identified factors that influence and sustain successful transitions from hospital to home. BMJ Open recently published a study that looked at a new factor—medication use—and its relationship to hospital readmission.

Researchers developed and internally validated a risk measure, the 80+ score, for rehospitalization and mortality among older patients. Their tool enhances previous measures by including a pharmacotherapy assessment.

The researchers also assessed the tool’s ability to discriminate by comparing it with 3 previously validated tools: Screening Tool of Older Person’s Prescriptions (STOPP), Screening Tool to Alert doctors to Right Treatment (START) and Medication Appropriateness Index (MAI). The randomized, controlled method they used to develop the tool included a comprehensive clinical pharmacist intervention.

The investigators enrolled 368 patients aged 80 years and older, and then measured time to rehospitalization or death in the year following discharge.

Elderly patients who had impaired renal function, pulmonary disease, or malignancies were at elevated risk of readmission, as were those discharged to a nursing home, the researchers found.

Risk increased when patients were prescribed opioids or any drug for peptic ulcer or gastroesophageal reflux disease. Those who received an antidepressant drug other than a tricyclic antidepressant, however, had lower risk of rehospitalization.

This study was the first to look at medication use as a predictor of rehospitalization. The research reminds pharmacists that adverse drug reactions cause up to 25% of hospitalizations, and approximately 50,000 Americans die from drug-related causes annually.

These findings expand pharmacists’ knowledge about inappropriate prescribing and flag opioids and drugs for peptic ulcer disease as a risk at discharge. Pharmacists are positioned to educate and monitor older patients who are discharged on these medications.