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Yes / Repeated hospital admissions are prevalent in older people. The role of medication in repeated hospital admissions has not been widely studied. The hypothesis that medication-related risk factors for initial hospital admissions were also associated with repeated hospital admissions was generated. To examine the association between medication-related risk factors and repeated hospital admissions in older people living with frailty. A retrospective case-control study was carried out with 200 patients aged ≥75 years with unplanned medical admissions into a large teaching hospital in England between January and December 2015. Demographic, clinical, and medication-related data were obtained from review of discharge summaries. Statistical comparisons were made between patients with 3 or more hospital admissions during the study period (cases) and those with 2 or fewer admissions (controls). Regressions were performed to establish independent predictors of repeated hospital admissions. Participants had a mean age of 83.8 years (SD 5.68) and 65.5% were female. There were 561 admission episodes across the sample, with the main reasons for admissions recorded as respiratory problems (25%) and falls (17%). Univariate logistic regression revealed five medication-related risks to be associated with repeated hospital admissions: Hyper-polypharmacy (defined as taking ≥10 medications) (OR 2.50, p < 0.005); prescription of potentially inappropriate medications (PIMs) (OR 1.89; p < 0.05); prescription of a diuretic (OR 1.87; p < 0.05); number of high risk medication (OR 1.29; p < 0.05) and the number of 'when required' medication (OR 1.20; p < 0.05). However, the effects of these risk factors became insignificant when comorbid disease was adjusted for in a multivariable model. Medication-related risk factors may play an important role in future repeated admission risk prediction models. The modifiable nature of medication-related risks factors highlights a real opportunity to improve health outcomes.

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Class of 2012 Abstract / Specific Aims: Determine the incidence of scheduled co-administration times in handwritten (paper) and electronic prepared medication administration records of oral ciprofloxacin and oral moxifloxacin with interacting substances that can affect fluoroquinolone gastrointestinal absorption. Also, determine the incidence of actual co-administration of oral ciprofloxacin and moxifloxacin with interacting substances that can affect fluoroquinolone gastrointestinal absorption with electronic and handwritten prepared medication administration records. Methods: Retrospective data was obtained by a chart review of patients from an academic medical center for a one month period before (May 2010) and after (August 2010) implementation of an electronic prepared medical administration record system. The scheduled time and actual time given for all fluoroquinolone antibiotics, as well as all possible interacting substances, were recorded. Main Results: A total of 99 subjects were included in this study (36 paper and 63 electronic). There was no statistical difference (p=0.47) between the percentage of scheduling errors for the electronic prepared medication administration records, 25.3%, compared to the paper medication administration records, 22.1%. However, there was a decrease in the percentage of actual co-administrations of fluoroquinolones with interacting substances for the electronic prepared MARs compared to paper prepared medication administration records; 22.3% and 32.1% respectfully (p=0.03). Conclusions: After implementing electronic prepared medication administration records at an academic institution, co-administration errors went down even though the amount of scheduling errors did not decrease.

Class of 2007 Abstract / Objectives: The purpose/objective of this study is to determine the effects of heat exposure, on the levels of active ingredient in three selected medications with narrow therapeutic indices: levothyroxine, epinephrine, and timolol. Methods: In order to complete the study, a variety of methods were carried out to simulate the desired and appropriate environmental conditions. The drug selection was based on the medications pharmacokinetic properties. Levothyroxine was considered ideal to include in the study due to the medication's short shelf life and narrow therapeutic window. Epinephrine was selected since it is a life-saving medication, which has been reported to degrade to a significant extent under extreme heat. Timolol was chosen since its liquid formulation can be unstable when exposed to extreme heat. Epi- Pen ®, levothyroxine 150 mcg, and timolol 0.5% were mailed from Phoenix on 7/12/06, via FedEx in order to simulate the mail order prescription delivery process. Alternatively, other samples of the medications were also placed at room temperature and a variety of heat and humidity conditions. The temperature and relative humidity profiles for the mail order drugs were monitored by a temperature and RH device. Three different assessments were made for each drug. Within each assessment, three analyses were conducted on that same sample. For the timolol drops, each 5ml (??)bottle was assayed three times in addition to baseline measurements. Likewise, the levothyroxine tablets and epinephrine injections each were analyzed three times from the same sample, from three different lots. In addition, we also examined the degredation of these three drugs when subjected to constant temperature exposure of 37, 45, 45 with RH, and 55 degrees Celsius in a lab oven. Samples were collected after 1-. 4-, and 7-days of heat exposure in both the mail box and the oven; 7/14/06, 7/17/06, and 7/20/06, respectively. Each medication was analyzed by its respective high-performance liquid chromatography (HPLC) method. The amount of drug taken for each sample was 0.5mL of epinephrine, 10 tablets of levothyroxine, and 0.5mL of timolol were used in the preparation for HPLC analysis. Results: The temperature and RH profile were recorded and graphed. The temperature measured in the mail box ranged from ~75 degreees Fahrenheit to ~140 degrees Fahrenheit. Based on the extrapolation to the baseline, the amount of drug measured on days 1, 4, and 7 were the following: 1) Levothyroxine: 123.66 mcg, 118.61mcg, and 119.3 mcg, respectively; 2) EpiPen: 1121.48 mcg/ml, 1215.52 mcg/ml, and 1167.22 mcg/ml, respectively; 3) timolol: 6766.30 mcg/ml, 6659.52 mcg/ml, and 6508.48 mcg/ml, respectively. Conclusions: The medications studied were exposed to temperatures above the manufacturer’s recommended storage conditions for the majority of the time. Despite being out of opitmal conditions, the results indicated that all three drugs did not have significant degradation.

Class of 2007 Abstract / Objectives: The purpose of this study is to assess the quality of study medications obtained without a prescription through international websites. Methods: Samples of levothyroxine, warfarin, and sildenafil were obtained through various websites and compared to U.S. standards. Each sample was physically evaluated for weight, color, shape, and external tablet markings. High performance liquid chromatography (HPLC) was performed to quantify the amount of active ingredient. Results: When physically inspected, only 3 of the 9 lots met FDA labeling requirements. Three of 60 (20 tablets from 3 lots) of the individual levothyroxine tablets were out of the USP acceptable range (90% - 110%). For warfarin, 16 of the 60 samples (20 samples from 3 lots) of the individual tablets were out of the USP acceptable range (95% - 105%). When averaged, each of the lots for both levothyroxine and warfarin were within their USP acceptable ranges. As sildenafil is not available as generic in the U.S., there is no USP standard acceptable range for comparison. All of the sildenafil samples fell within 90%- 105% of Viagra® tablets obtained from a local pharmacy. Conclusions: While there were a few samples outside of the U.S. acceptable range, the majority of samples analyzed for active ingredient were within the range published in the USP. While the outcomes of this study presented interesting findings, further evaluation in larger studies is needed to properly assess the quality of foreign medications purchased over the internet.

Class of 2007 Abstract / Objectives: To investigate the relationship of price and prevalence of statins when new mediations enter the market and when old medications are withdrawn from the market. Methods: Patients that received a statin were enrolled in the Medicare Current Beneficiary Survey (MCBS) from 1992 to 2002. The overall prevalence of each statin as well as the prevalence of each statin for a patient’s drug coverage (no coverage, Medicaid, Medigap, employer coverage, or other public coverage) were analyzed. Results: The overall prevalence of statin was statistically significant for 1992 versus 2002 (p<0.001). When atorvastatin came to the market towards the end of 1996, there was no difference between simvastatin (p=0.24) and pravastatin (p=0.12) in 1997 versus 1998. Conclusions: There was a difference in the prevalence of statins when atorvastatin entered the market. When cerivastatin left the market, there was a difference in the prevalence of statin use. Atorvastatin became the most prevalent statin by the end of 2002. The price of statins appeared to decrease over time from $39.01 in 1992 to $31.95 in 2002. Also, the year atorvastatin was released the average price of statins increased to $36.57 in 1997.

Class of 2008 Abstract / Objectives: To compare the completeness of patient medication history collected upon admission at the University Medical Center (UMC) in Tucson, Arizona with that collected by RxAccordTM insurance claims database. Methods: An inferential retrospective chart review. A random list of 300 patients admitted to UMC from January 1, 2007 to June 30, 2007 who utilized specific insurance companies was obtained. Of those 300 patients, the first 100 patients found in the RxAccordTM database were included in this study. UMC recorded admission medication history was noted for each patient and compared against the RxAccordTM retail pharmacy adjudicated medication database. The main outcome measured was the number of medication discrepancies. The independent variable was the type of medication reconciliation conducted (RxAccordTM ) vs. physician compiled upon admission to UMC. Results: A total of ninety-five charts were used in this study. UMC admission medication reconciliation records had an average of 2.21 missing medications per patient whereas RxAccordTM had an average of 1.01 missing medications per patient. Of the medications missing on the RxAccordTM database, almost 50% (46/96) were OTC medications. On average, UMC had fifty-one medications that had discrepancies (i.e. route, strength or directions). On the other hand, RxAccordTM contained no discrepancies. A total of 17 out 95 records (18%) were missing medication reconciliation forms in their medical record. Conclusions: Information collected by RxAccordTM produced a more complete patient medication reconciliation history than that compiled upon admission at UMC. An insurance claims database may provide, a significantly more accurate method of medication reconciliation.

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