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.

Older people living with frailty are at a higher risk of medication-related incidents due to frequent hospitalisation, complex health needs and polypharmacy. There is evidence that identifying patients at high risk of hospital readmission can enhance the impact of interventions to prevent readmission. However, there is insufficient evidence of the role of medication in readmission in this vulnerable patient group, and what pharmacists can do to reduce readmissions. This research used a mixed-method approach to examine the association between medicines-related risks and readmissions, and the pharmacists’ interventions thought to be important by key stakeholders to reduce readmissions. Medicines-related risks such as polypharmacy, potentially inappropriate medicines and high risk medicines did not have a strong association with repeated hospital admission in multivariable logistic regression. Patients who had multi-morbidities, and non-supported discharge, had a higher risk of repeated hospital admissions. A consensus survey study with three iterative rounds identified a list of pharmacists’ interventions viewed as high priority for reducing readmissions in frail elderly patients. The interventions with the highest scores included medicines reconciliation at discharge, on admission, preparation of discharge summary, provision of tailored patient education about medicines and inter-disciplinary working in ward rounds. A systematic intervention development method was used to further develop an intervention, underpinned by the theoretical domains framework. There is a need to further explore the role of medication-related risks in contributing to readmission using other validated tools and larger datasets. This could be used to inform development of future risk stratification tools to identify high risk patients in order to target interventions to maximise its impact. / University of Bradford and Sheffield Teaching Hospital studentship