Polypharmacy in the Homebound Population

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Abstract

The number of homebound elders has risen dramatically in the past decade and was accelerated by the Sars-Cov-2 COVID-19 pandemic. These individuals generally have 5 or more chronic conditions, take 6 or more medications, and are at elevated risk for functional decline. Polypharmacy constitutes a major burden for these individuals, putting them at risk for medication nonadherence, medication errors, medication interactions, and reduced quality of life. A team-based approach may help these elders manage medications more effectively.

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Rehospitalizations among patients in the Medicare fee-for-service program.

Stephen Jencks, Mark Williams, Eric A Coleman (2009)

Reducing rates of rehospitalization has attracted attention from policymakers as a way to improve quality of care and reduce costs. However, we have limited information on the frequency and patterns of rehospitalization in the United States to aid in planning the necessary changes. We analyzed Medicare claims data from 2003-2004 to describe the patterns of rehospitalization and the relation of rehospitalization to demographic characteristics of the patients and to characteristics of the hospitals. Almost one fifth (19.6%) of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were rehospitalized within 30 days, and 34.0% were rehospitalized within 90 days; 67.1% [corrected] of patients who had been discharged with medical conditions and 51.5% of those who had been discharged after surgical procedures were rehospitalized or died within the first year after discharge. In the case of 50.2% [corrected] of the patients who were rehospitalized within 30 days after a medical discharge to the community, there was no bill for a visit to a physician's office between the time of discharge and rehospitalization. Among patients who were rehospitalized within 30 days after a surgical discharge, 70.5% were rehospitalized for a medical condition. We estimate that about 10% of rehospitalizations were likely to have been planned. The average stay of rehospitalized patients was 0.6 day longer than that of patients in the same diagnosis-related group whose most recent hospitalization had been at least 6 months previously. We estimate that the cost to Medicare of unplanned rehospitalizations in 2004 was $17.4 billion. Rehospitalizations among Medicare beneficiaries are prevalent and costly. 2009 Massachusetts Medical Society

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Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care.

Sunil Kripalani, Frank Lefèvre, Christopher Phillips … (2007)

Delayed or inaccurate communication between hospital-based and primary care physicians at hospital discharge may negatively affect continuity of care and contribute to adverse events. To characterize the prevalence of deficits in communication and information transfer at hospital discharge and to identify interventions to improve this process. MEDLINE (through November 2006), Cochrane Database of Systematic Reviews, and hand search of article bibliographies. Observational studies investigating communication and information transfer at hospital discharge (n = 55) and controlled studies evaluating the efficacy of interventions to improve information transfer (n = 18). Data from observational studies were extracted on the availability, timeliness, content, and format of discharge communications, as well as primary care physician satisfaction. Results of interventions were summarized by their effect on timeliness, accuracy, completeness, and overall quality of the information transfer. Direct communication between hospital physicians and primary care physicians occurred infrequently (3%-20%). The availability of a discharge summary at the first postdischarge visit was low (12%-34%) and remained poor at 4 weeks (51%-77%), affecting the quality of care in approximately 25% of follow-up visits and contributing to primary care physician dissatisfaction. Discharge summaries often lacked important information such as diagnostic test results (missing from 33%-63%), treatment or hospital course (7%-22%), discharge medications (2%-40%), test results pending at discharge (65%), patient or family counseling (90%-92%), and follow-up plans (2%-43%). Several interventions, including computer-generated discharge summaries and using patients as couriers, shortened the delivery time of discharge communications. Use of standardized formats to highlight the most pertinent information improved the perceived quality of documents. Deficits in communication and information transfer at hospital discharge are common and may adversely affect patient care. Interventions such as computer-generated summaries and standardized formats may facilitate more timely transfer of pertinent patient information to primary care physicians and make discharge summaries more consistently available during follow-up care.

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Improving the quality of transitional care for persons with complex care needs.

Eric A Coleman, Chad Boult (2003)

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Author and article information

Journal

Journal ID (nlm-ta): Clin Geriatr Med

Journal ID (iso-abbrev): Clin Geriatr Med

Title: Clinics in Geriatric Medicine

Publisher: Elsevier Inc.

ISSN (Print): 0749-0690

ISSN (Electronic): 1879-8853

Publication date PMC-release: 13 September 2022

Publication date (Electronic): 13 September 2022

Affiliations

[a ]UCLA Division of Geriatrics

[b ]UCLA Department of Medicine, Division of Geriatrics, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095, USA

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[∗ ]Corresponding author.

Article

Publisher Item ID: S0749-0690(22)00030-1

DOI: 10.1016/j.cger.2022.05.008

PMC ID: 9468911

SO-VID: 105b462c-f7da-4284-8167-298a9491d26c

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Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Polypharmacy in the Homebound Population

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Novel Coronavirus Disease COVID-19

Most cited references 36

Rehospitalizations among patients in the Medicare fee-for-service program.

Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care.

Improving the quality of transitional care for persons with complex care needs.

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