Introduction
Medication-related harm is an underdiagnosed problem in
Australia,1 costing the Australian healthcare system
about A$1.4 billion per annum.2 The older population
(aged ≥65 years) is particularly vulnerable to medication-related harm
due to their advanced age, multimorbidity and increased use of
medications (polypharmacy).3 Increased medication use
is, in turn, linked to potentially inappropriate prescribing
(PIP).4,5 Potentially inappropriate prescribing
comprises the use of potentially inappropriate medications (PIMs) where
the risks outweigh clinical benefits and potential prescribing omissions
(PPOs), which is the failure to prescribe medications that provide
benefits.6Recent reviews have shown that
PIPs are common among older adults in diverse healthcare settings, and
are associated with medication-related hospitalisation, adverse drug
reactions, adverse drug events, and functional
decline.7,8 A systematic review and meta-analysis of
63 included studies has shown that patients using at least 1 PIM in the
inpatient setting (compared with non-users) were associated with a 91%
increased odds of medication-related hospital admission, and 60%
increased odds of dependency in at least 1 activity of daily
living.7
Multiple screening tools are available to detect and reduce PIPs among
older adults, such as the Screening Tool of Older Person’s Prescriptions
and the Screening Tool to Alert doctors to Right Treatment (STOPP/START)
criteria, and the Beers criteria.9 These are also the
tools commonly used in research in Australian healthcare
setting.10-14 PIP, according to STOPP/START criteria,
have been investigated mainly through retrospective analysis in acute
care settings,11-13 with high variability in
prevalence estimates between care transition points. A clinical audit of
electronic medical records of 249 older people from an Australian
teaching hospital found 51% were exposed to at least 1 PIM at hospital
admission and, this prevalence was reduced to 37% at
discharge.12 In contrast, another Australian study
found an increase in the prevalence of PIM use from hospital admission
to discharge (54.8% vs 60.8%).13 In addition,
results from previous international studies on the influence of
inappropriate prescribing on post-discharge health outcomes are mixed.
While some studies highlighted
the presence of PIMs/PPOs was significantly associated with potentially
preventable medication-related hospital admissions,15repeated hospital admissions and mortality,16 other
investigations did not confirm these findings with respect to
post-discharge health outcomes, including rehospitalization and
mortality either in acute care17-19 or geriatric
rehabilitation settings.20 Moreover,
evidence is limited on PIM/PPO
prevalence as well as their associations with post-discharge health
outcomes in patients admitted to and discharged from geriatric
rehabilitation settings.
The purpose of this study was to assess the prevalence of PIM and PPO
use at transitions of geriatric rehabilitation care (acute admission,
admission to and discharge from geriatric rehabilitation) and to
investigate the associations between PIMs, PPOs, and number of
medications identified at discharge from geriatric rehabilitation with
subsequent post-discharge health outcomes, including hospital
readmissions and mortality.