Identifying adverse drug events after discharge from a community hospital

Background: Adverse drug events that occur after discharge from the hospital are a major public health concern that deserves much more attention. Most of the existing studies that investigated postdischarge adverse drug events were limited to urban populations and did not specifically examine rural populations. We present preliminary results, from a recently funded R01 AHRQ grant, on the frequency of postdischarge adverse drug events in rural patients and compare results with urban patients.

Methods: Adverse drug events are defined as medication related injuries occurring as a result of medical management. Patients were recruited prospectively prior to discharge from a hospitalist service of a community hospital. Postdischarge adverse drug events were determined by performing an independent implicit health record review (both inpatient and outpatient) and a structured telephone interview approximately 3-weeks after discharge from the hospital. We provide frequencies and an odds ratio with 95% confidence intervals (CI) to estimate the likelihood of rural patients experiencing a postdischarge adverse drug event when compared to urban patients.

Results: Health record reviews and telephone interviews were completed for 406 patients. One hundred ninety-eight (48.8%) were rural patients and 208 (51.2%) were urban patients. Fifty-six (13.8%) of 406 patients experienced postdischarge adverse drug events. Of these, 26 (46.4%) were rural patients and 30 (53.6%) were urban patients. The odds ratio was 0.91 (95% CI: 0.46-1.82) for rural patients experiencing a postdischarge adverse drug event when compared to urban patients.

Conclusion: Preliminary results do not indicate statistically significant differences for experiencing postdischarge adverse drug events when comparing rural with urban patients. We expect to have completed health record reviews and telephone interviews for 608 patients by November 2013.