Medication-related harm (MRH) is common in older adults following hospital discharge. A study found that clinical judgment of doctors is not a reliable tool to predict MRH in older adults post-discharge.

A new British Journal of Clinical Pharmacology study has examined whether doctors can predict which older patients will experience MRH requiring care following hospital discharge and whether clinical experience and confidence in prediction influence the accuracy of predictions.

A multicentre observational prospective study involving five teaching hospitals in England between September 2013 and November 2015. Doctors discharging patients (aged ≥65 years) from medical wards predicted the likelihood of their patient experiencing MRH requiring healthcare (hospital readmission or community health care) in the initial 8 week period post?discharge. Patients were followed up by senior pharmacists to determine MRH occurrence.

In the multicenter observational prospective study involving five teaching hospitals in England between September 2013 and November 2015, there were 1066 patients with completed predictions and follow-up.

Doctors discharging older patients from medical wards predicted the likelihood of their patient experiencing MRH requiring care in the initial eight week period post-discharge.

Hospital readmission

Most predictions (85%) were made by junior doctors with less than five years' clinical experience. There was no relationship between doctors' predictions and patient MRH, irrespective of years of clinical experience.

Doctors' predictions were more likely to be accurate when they reported higher confidence in their prediction, especially in predicting MRH-associated hospital readmissions.

Data of 1066 patients (83%) with completed predictions and follow?up, out of 1280 recruited patients, were analyzed. Patients had a median age of 82 years (65 to 103 years), and 58% were female.

Most predictions (85%) were made by junior doctors with less than 5 years' clinical experience. There was no relationship between doctors' predictions and patient MRH (OR 1.10, 95% CI 0.82?1.46, p=0.53), irrespective of years of clinical experience.

Doctors' predictions were more likely to be accurate when they reported higher confidence in their prediction, especially in predicting MRH?associated hospital readmissions (OR 1.58, 95% CI 1.42?1.76, p<0.001).

"These findings confirm the complexity of predicting medication-related harm. This makes it very challenging to target medication-related strategies to the right individuals," said Dr. Khalid Ali, chief investigator of the study and senior lecturer in Geriatrics at Brighton and Sussex Medical School.

"Clinical pharmacology and therapeutics teaching have not been particularly prominent in undergraduate medical training. This is perhaps an area requiring review, given an aging population that is prescribed ever-increasing quantities of medicine," said Dr. Khalid Ali.

Dr. Ali added that there is a need to consider new approaches to identify individuals at high risk of medication-related harm given its serious impact on patients and healthcare services.