Suboptimal medication-related quality of care preceding hospitalisation of older patients

Objective: To examine the prevalence of suboptimal medication-related processes of care before the hospitalisation of older patients. Design and setting: We conducted a retrospective cohort study using a clinical indicator set related to medication management that has been validated by an expert panel as consisting of suboptimal aspects of medication use that clinicians should be able to foresee and avoid. Australian Government Department of Veterans’ Affairs administrative claims data between 1 July 2007 and 30 June 2012 were analysed according to these clinical indicators to assess medication-related processes of care preceding hospitalisation. Participants: Veterans with one or more hospitalisations in Australia for a condition defined by the clinical indicator set. Main outcome measure: Prevalence of suboptimal medication-related processes of care before hospitalisation as a proportion of all hospitalisations defined by diagnoses in the clinical indicator set. Results: During the 5-year study period, there were 164 813 hospitalisations with primary diagnoses for conditions included in the clinical indicator set, encompassing 83 430 patients. The overall proportion of hospitalisations that were preceded by suboptimal medication-related processes of care was 25.2% (41 546 hospitalisations); 34.5% of patients (28 807 patients) had at least one hospitalisation and 10.4% (8640 patients) had two or more hospitalisations preceded by suboptimal medication-related processes of care. At least one in 10 hospitalisations for chronic heart failure, ischaemic stroke, asthma, gastrointestinal ulcer or bleeding, fracture, renal failure or nephropathy, hyperglycaemia or hypoglycaemia were preceded by suboptimal medication-related processes of care. Conclusions: This study highlights conditions for which there are evidence–practice gaps in medication management in the older population. Routine prospective monitoring of these evidence-based, validated, medication-related clinical indicators provides a means for quality improvement in the management of common chronic conditions.