Developing indicators for medication-related readmissions based on a Delphi consensus study

Nicole Schönenberger; Anne-Laure Blanc; Balthasar L Hug; Manuel Haschke; Aljoscha N Goetschi; Ursina Wernli; Carla Meyer-Massetti

doi:10.1016/j.sapharm.2024.02.012

Developing indicators for medication-related readmissions based on a Delphi consensus study

Res Social Adm Pharm. 2024 Jun;20(6):92-101. doi: 10.1016/j.sapharm.2024.02.012. Epub 2024 Feb 27.

Authors

Nicole Schönenberger¹, Anne-Laure Blanc², Balthasar L Hug³, Manuel Haschke⁴, Aljoscha N Goetschi⁵, Ursina Wernli⁵, Carla Meyer-Massetti⁶

Affiliations

¹ Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland. Electronic address: nicole.schoenenberger@insel.ch.
² Pharmacy of the Eastern Vaud Hospitals, 1847, Rennaz, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1205, Geneva, Switzerland.
³ Department of Internal Medicine, Lucerne Cantonal Hospital, 6000, Lucerne, Switzerland; University of Lucerne, Faculty of Health Sciences and Medicine, 6005, Lucerne, Switzerland.
⁴ Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland.
⁵ Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland.
⁶ Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Institute of Primary Healthcare (BIHAM), University of Bern, 3012, Bern, Switzerland.

PMID: 38433064
DOI: 10.1016/j.sapharm.2024.02.012

Abstract

Background: Medication-related readmissions challenge healthcare systems by burdening patients, increasing costs and straining resources. However, to date, there has been no consensus study on indicators for medication-related readmissions.

Objectives: This Delphi study aimed to develop a consensus-based set of indicators for detecting patients at risk of medication-related readmission.

Methods: An expert panel of clinical pharmacists, physicians and nursing experts participated in a two-round Delphi study. In round 1, 31 indicators taken from the literature were rated for relevance on a scale from 1 to 9, with a median rating of 7 or higher suggesting relevance. The RAND/UCLA method was used to determine consensus. In round 2, indicators lacking consensus were re-rated together with a series of new indicators generated by the experts. Additional details were sought for some indicators. The main outcomes were the relevance of, consensus on, and completeness of the proposed indicators for identifying risks of 30-day medication-related readmission.

Results: Thirty-eight experts participated in round 1. Consensus was found for all the indicators, with 25 included and 6 excluded. Thirty-four experts participated in round 2. Consensus was found for all 5 newly suggested indicators, and 4 were included. The expert panel prioritized the following indicators: (1) insufficient communication between different healthcare providers, (2) polypharmacy (≥7 medications), (3) low rates of medication adherence (twice-weekly mistakes or missing administration), (4) complex medication regimens (≥3 doses, ≥2 dosage forms and ≥2 administration routes per day), and (5) multimorbidity (≥3 chronic conditions). The final set comprised 29 indicators.

Conclusions: The indicator set developed for flagging potential medication-related readmissions could guide priorities for clinical pharmacy services at hospital discharge, improving patient outcomes and resource use. A validation study of these indicators is planned.

Keywords: Clinical pharmacy; Drug-related readmission; Hospital discharge; Medication safety; Risk factor; Transition of care.

MeSH terms

Consensus*
Delphi Technique*
Female
Humans
Male
Patient Readmission* / statistics & numerical data
Pharmacists* / organization & administration
Physicians