Adverse drug events after hospitalization: 'These are the sickest people that we have who are not in the hospital'

Those days and weeks after a hospitalization are often a demanding, sometimes confusing time for patients, their loved ones and the providers taking care of them, says Joshua Pevnick, M.D., M.S.H.S. A lot can go wrong with medications that people are taking.

“Some of the medications don’t get appropriately continued at hospitalization, or they might get inappropriately started because people thought they were on them when they were not,” says Pevnick, an associate professor at Cedars-Sinai Medical Center in Los Angeles. “There’s just a lot going on at that time. It’s almost like a big reset at hospital admissions.”

Moreover, Pevnick notes, patients coming out of the hospital who are recovering from surgery, trauma, or severe illness are more physiologically prone to an adverse drug event than others. “These are the sickest people we have who are not in the hospital.

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Pevnick was the lead author of a pragmatic randomized trial of pharmacist-led medication management program at Cedars-Sinai and Brigham and Women’s Hospital in Boston designed with the intention of preventing posthospitalization adverse drug events. The results, published earlier this week in JAMA Network Open, showed that the intervention came up short when it came to the primary end point of unplanned hospital and emergency room utilization in the 30-day period after discharge, but a secondary analysis showed a positive effect in a smaller group of patients with low medication adherence and literacy.

In the JAMA Network Open paper, Pevnick and his colleagues referenced research that has shown 5% to 6% of older patients have posthospitalization adverse drug events.

“I both see this [adverse drug events] a lot and I have a lot of fear of it, because I know that we’re not doing a good job a lot of the time,” Pevnick said.

He continued, “This is not like developing a new drug or something where you need to spend billions of dollars on research. This is just taking the information that we have and applying it in the best way.”