Association of a Novel Medication Risk Score with Adverse Drug Events and Other Pertinent Outcomes Among Participants of the Programs of All-Inclusive Care for the Elderly
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Setting, and Context
2.2. Study Sample
2.3. Definitions, Terms, and Measures
2.3.1. The Novel MRS
2.3.2. ADEs
2.3.3. Pertinent Risk Outcomes
2.4. Statistical Procedures
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
ICD Code | Description | n (%) |
---|---|---|
T38.0 | Glucocorticoids and synthetic analogues | 4 (2.4) |
F15.1 | Mental and behavioral disorders due to use of other stimulants, including caffeine: harmful use | 4 (2.4) |
T38.3 | Insulin and oral hypoglycemic (antidiabetic) drugs | 4 (2.4) |
F15.9 | Mental and behavioral disorders due to use of other stimulants, including caffeine: unspecified mental and behavioral disorder | 4 (2.4) |
I95.2 | Hypotension due to drugs | 3 (1.8) |
E16.0 | Drug-induced hypoglycemia without coma | 3 (1.8) |
F15.2 | Mental and behavioral disorders due to use of other stimulants, including caffeine: dependence syndrome | 3 (1.8) |
T42.6 | Other antiepileptic and sedative-hypnotic drugs | 3 (1.8) |
T40.4 | Poisoning by other synthetic narcotics (buprenorphine, pethidine, dextropropoxyphene, etc.) | 3 (1.8) |
T42.8 | Antiparkinsonism drugs and other central muscle-tone depressants | 2 (1.2) |
G25.1 | Drug-induced tremor | 2 (1.2) |
F11.1 | Mental and behavioral disorders due to use of opioids: harmful use | 2 (1.2) |
F19.9 | Mental and behavioral disorders due to multiple drug use and use of other psychoactive substances: unspecified mental and behavioral disorder | 2 (1.2) |
M87.1 | Osteonecrosis due to drugs | 2 (1.2) |
R50.2 | Drug-induced fever | 2 (1.2) |
T45.1 | Antineoplastic and immunosuppressive drugs | 2 (1.2) |
E03.2 | Hypothyroidism due to medicaments and other exogenous substances | 2 (1.2) |
T78.3 | Angioneurotic edema | 2 (1.2) |
T50.3 | Electrolytic, caloric, and water-balance agents | 2 (1.2) |
T42.0 | Hydantoin derivatives | 2 (1.2) |
E27.3 | Drug-induced adrenocortical insufficiency | 1 (0.6) |
T50.2 | Carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics | 1 (0.6) |
L56.0 | Drug phototoxic response | 1 (0.6) |
Z03.6 | Observation for suspected toxic effect from ingested substance | 1 (0.6) |
T43.5 | Other and unspecified antipsychotics and neuroleptics | 1 (0.6) |
T37.1 | Antimycobacterial drugs | 1 (0.6) |
D61.1 | Drug-induced aplastic anemia due to chemotherapy | 1 (0.6) |
T39.3 | Other nonsteroidal anti-inflammatory drugs (NSAID) | 1 (0.6) |
T43.6 | Poisoning by psychostimulants with abuse potential | 1 (0.6) |
H40.6 | Glaucoma secondary to drugs | 1 (0.6) |
T42.4 | Poisoning by benzodiazepines | 1 (0.6) |
T38.1 | Thyroid hormones and substitutes | 1 (0.6) |
T37.8 | Other specified systemic anti-infectives and antiparasitics (poisoning) | 1 (0.6) |
F13.2 | Mental and behavioral disorders due to use of sedatives or hypnotics: dependence syndrome | 1 (0.6) |
T46.2 | Other antidysrhythmic drugs, not elsewhere classified | 1 (0.6) |
T46.1 | Calcium-channel blockers (poisoning) | 1 (0.6) |
T88.7 | Unspecified adverse event of drug or medicament | 1 (0.6) |
L64.0 | Drug-induced androgenic alopecia | 1 (0.6) |
T42.3 | Barbiturates (poisoning) | 1 (0.6) |
G44.4 | Drug-induced headache, not elsewhere classified | 1 (0.6) |
T44.7 | Beta-adrenoreceptor antagonists, not elsewhere classified | 1 (0.6) |
N14.2 | Nephropathy induced by unspecified drug, medicament or biological substance | 1 (0.6) |
T37.0 | Sulfonamides (poisoning) | 1 (0.6) |
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Characteristic | Total | Participants without ADEs | Participants with ADEs |
---|---|---|---|
PACE participants, n (%) | 1965 (100) | 1837 (93.5) | 128 (6.5) |
Age, mean ± SD (range) | 76.8 ± 9.9 (56–104) | 77.1 ± 9.9 (56–104) | 72.9 ± 9.7 (56–96) |
Age, median (IQR) | 77 (69, 84) | 77 (69, 84) | 71 (66, 80) |
Female, n (%) | 1282 (65.2) | 1206 (65.7) | 76 (59.4) |
Number of profiled medications, mean ± SD (range) 1 | 13.4 ± 5.8 (1–42) | 13.2 ± 5.8 (1–42) | 16.2 ± 6.1 (4–37) |
Number of profiled medications, median (IQR) 1 | 13 (9, 17) | 13 (9, 17) | 15.5 (12, 20) |
MedWise Risk Score™, mean ± SD (range) | 18.5 ±7.8 (2–40) | 18.2 ± 7.7 (2–40) | 23.1 ± 7.8 (3–40) |
MedWise Risk Score™, median (IQR) | 18 (12, 25) | 18 (12, 24) | 23 (17.75, 29) |
Ethnicity, n (%) | |||
Non-Hispanic White | 1140 (58.0) | 1061 (57.8) | 79 (61.7) |
Black | 454 (23.1) | 422 (23.0) | 32 (25.0) |
Hispanic | 142 (7.2) | 135 (7.3) | 7 (5.5) |
Asian or Pacific Islander | 59 (3.0) | 58 (3.2) | 1 (0.8) |
American Indian/Alaskan Native | 7 (0.4) | 7 (0.4) | 0 (0.0) |
Unknown or other | 163 (8.3) | 154 (8.4) | 9 (7.0) |
Top chronic comorbidities (by diagnosis code), n (%) | |||
Essential (primary) hypertension | 1233 (62.7) | 1135 (61.8) | 98 (76.6) |
Type 2 diabetes mellitus without complications | 790 (40.2) | 727 (39.6) | 63 (49.2) |
Hyperlipidemia, unspecified | 622 (31.7) | 573 (31.2) | 49 (38.3) |
Atherosclerotic heart disease of native coronary artery without angina pectoris | 428 (21.8) | 388 (21.1) | 40 (31.2) |
Hypothyroidism, unspecified | 421 (21.4) | 385 (21.0) | 36 (28.1) |
Unspecified dementia without behavioral disturbance | 406 (20.7) | 374 (20.4) | 32 (25.0) |
Chronic obstructive pulmonary disease, unspecified | 373 (19.0) | 335 (18.2) | 38 (29.7) |
Chronic kidney disease, stage 3 | 371 (18.9) | 335 (18.2) | 36 (28.1) |
Heart failure, unspecified | 349 (17.8) | 314 (17.1) | 35 (27.3) |
Pertinent risk outcomes | |||
Total medical expenditures, mean (95% CI), USD | $26,299.97 (24,917.54, 27,682.39) | $25,087.07 (23,720.95, 26,453.19) | $43,706.95 (36,149.34, 51,264.56) |
Hospital admissions, mean (95% CI), n per participant per year | 0.37 (0.33, 0.41) | 0.34 (0.3, 0.37) | 0.84 (0.62, 1.05) |
Hospital length of stay, mean (95% CI), days | 2.1 (1.8, 2.4) | 1.9 (1.7, 2.2) | 4.8 (3.3, 6.2) |
ED visits, mean (95% CI), n per participant per year | 0.63 (0.57, 0.69) | 0.59 (0.53, 0.65) | 1.21 (0.88, 1.54) |
PACE organizations, n | 12 | ||
Geographic location of PACE, n (%) | |||
Northeast | 3 (25.0) | ||
South | 4 (33.3) | ||
Midwest | 1 (8.3) | ||
West | 4 (33.3) | ||
PACE census size, n (%) | |||
<120 participants | 1 (8.3) | ||
120–220 participants | 7 (58.3) | ||
>220 participants | 4 (33.3) |
ICD Code | Description | n (%) |
---|---|---|
F11.2 | Mental and behavioral disorders due to use of opioids: dependence syndrome | 20 (11.8) |
F11.9 | Mental and behavioral disorders due to use of opioids: unspecified mental and behavioral disorder | 12 (7.1) |
D68.3 | Hemorrhagic disorder due to circulating anticoagulants | 11 (6.5) |
F19.1 | Mental and behavioral disorders due to multiple drug use and use of other psychoactive substances: harmful use | 9 (5.3) |
T50.9 | Poisoning: other and unspecified drugs, medicaments, and biological substances | 9 (5.3) |
G24.0 | Drug-induced dystonia | 7 (4.1) |
L27.0 | Generalized skin eruption due to drugs and medicaments | 6 (3.5) |
T40.2 | Poisoning by other opioids (includes morphine and codeine) | 5 (2.9) |
G21.1 | Other drug-induced secondary parkinsonism | 5 (2.9) |
T45.5 | Anticoagulants (poisoning) | 5 (2.9) |
F19.2 | Mental and behavioral disorders due to multiple drug use and use of other psychoactive substances: dependence syndrome | 5 (2.9) |
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Bankes, D.L.; Jin, H.; Finnel, S.; Michaud, V.; Knowlton, C.H.; Turgeon, J.; Stein, A. Association of a Novel Medication Risk Score with Adverse Drug Events and Other Pertinent Outcomes Among Participants of the Programs of All-Inclusive Care for the Elderly. Pharmacy 2020, 8, 87. https://doi.org/10.3390/pharmacy8020087
Bankes DL, Jin H, Finnel S, Michaud V, Knowlton CH, Turgeon J, Stein A. Association of a Novel Medication Risk Score with Adverse Drug Events and Other Pertinent Outcomes Among Participants of the Programs of All-Inclusive Care for the Elderly. Pharmacy. 2020; 8(2):87. https://doi.org/10.3390/pharmacy8020087
Chicago/Turabian StyleBankes, David L., Hubert Jin, Stephanie Finnel, Veronique Michaud, Calvin H. Knowlton, Jacques Turgeon, and Alan Stein. 2020. "Association of a Novel Medication Risk Score with Adverse Drug Events and Other Pertinent Outcomes Among Participants of the Programs of All-Inclusive Care for the Elderly" Pharmacy 8, no. 2: 87. https://doi.org/10.3390/pharmacy8020087