Yang Z, Olomu A, Corser W, Rovner D, Sheps D, HolmesRover M; AcademyHealth. Meeting (2005 : Boston, Mass.).
Abstr AcademyHealth Meet. 2005; 22: abstract no. 4345.
University of Florida, Health Services Research, Management and Policy, 101 S Newell Dr. Rm 4141, Gainesville, FL 32610-0195 Tel. 352-273-6081 Fax 352-273-6075
RESEARCH OBJECTIVE: The importance of outpatient cardiac medication use for patients has been widely recognized, and is a primary focus of quality improvement. While previous research has suggested that hospital discharge is a critical time to promote the initial and continued use of cardiac medications for Acute Coronary Syndrome (ACS) patients, little research has investigated the effects of ongoing outpatient drug use patterns after hospital discharge. Our objective was to analyze patterns of outpatient cardiac medication use after initial hospitalization for ACS, and investigate the impact on the probability of subsequent hospital readmissions. STUDY DESIGN: This is an observational study using secondary data. Chart reviews are merged with data from post hospitalization surveys about health care utilization and health outcomes conducted at 3 time points: immediately after discharge, 3 months, and 8 months after discharge. We conducted a descriptive analysis to examine the dynamic feature of post-acute ACS patient care, particularly changing patterns of outpatient prescription drug use, post-discharge hospital readmissions, and Emergency Department (ED) visits. Series of multivariable logistic regression models were used to estimate the association between post ACS medication use and hospital readmission and ED visits by the 3 and 8 months telephone surveys. POPULATION STUDIED: 433 patients prospectively identified with ACS in five mid-Michigan community hospitals during the period January 2002 to April 2003 PRINCIPAL FINDINGS: Most changes to medication regimens use occurred within 3 months after discharge, with fewer changes in the subsequent 5 months. Taking Beta-Blockers (odds ratio, 0.46 [95% CI, 0.21 to 0.99]) or Angiotensin-Converting Enzyme Inhibitors (ACEI) (odds ratio, 0.31 [95% CI, 0.13 to 0.77]) significantly reduced the probability of hospital readmission within 3 months after discharge (P<0.05). Higher adherence to ACEI after discharge contributed to even lower hospital readmission rate (odds ratio, 0.55 [95% CI, 0.34-0.89], p<0.1). Re-hospitalized within 3 months after discharge was a strong predictor of later hospital readmission up to 8 months after discharge (odds ratio 0.74 [95% CI 0.73 to 1.74] p<0.05) CONCLUSIONS: In addition to the prescription of effective discharge medications, timely and appropriate medication adjustment in outpatient settings appears to improve health outcomes in ACS patients. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Time interval shortly after discharge could be a good opportunity to initiate and promote drug therapy for post ACS patients, which indicates the important role of outpatient care physicians. More research, especially longitudinal studies are expected to be conducted at outpatient clinical settings to investigate the effect of physician-patients relationships on continuity of health care as well as subsequent health outcomes of post ACS patients.
Publication Types:
Keywords:
- Acute Disease
- Ambulatory Care
- Heart Failure
- Hospitalization
- Humans
- Inpatients
- Longitudinal Studies
- Michigan
- Myocardial Ischemia
- Odds Ratio
- Patient Discharge
- Patient Readmission
- Prescriptions, Drug
- hsrmtgs
UI: 103623808
From Meeting Abstracts