Emergency Department Reconsultations After a Secondary Prevention Bundle for Medication-Related Problems: A Retrospective Cohort Study

TL;DR

A pharmacist-led intervention in emergency departments reduced medication-related reconsultations, with most recurrences linked to gastrointestinal issues and seizures.

Contribution

This study evaluates a new pharmacist-led ED intervention bundle and its impact on medication-related reconsultations.

Findings

30-day ED reconsultation rate was 9.6%, with 30.8% of these linked to medication-related problems.

Gastrointestinal bleeding and seizures were the most common recurring medication-related issues.

Older patients (≥80 years) had a lower risk of DRP-related revisits.

Abstract

Background/Objective: Drug-related problems (DRPs) are a common, potentially avoidable cause of emergency department (ED) use. In December 2022, our hospital integrated a pharmacist-led intervention into routine ED practice. This intervention comprised medication optimization, adherence counseling, and coordinated hand-off to primary care. We quantified 30- and 90-day reconsultations after discharge and explored factors associated with DRP-related revisits. Methods: A retrospective cohort of adults (≥18 years) who attended a tertiary ED (Barcelona, Spain). We included index DRP visits from 1 December 2022 to 30 June 2024. All received the bundle. Demographic, clinical, and pharmacotherapeutic data were extracted from the Catalan Shared Health Record; an independent committee classified revisits as a DRP or non-DRP. Predictors of 30-day DRP revisits were assessed with multivariable logistic regression. Results: Among 1247 patients (mean age 78.6 ± 16.2 years; 59.2% women; and median nine drugs), 120 (9.6%) reconsulted the ED within 30 days, and 194 (15.5%) within 90 days for any cause. DRP-specific rates were 30.8% (37/120) at 30 days and 26.3% (51/194) at 90 days; 81% and 80% of these revisits, respectively, involved a recurrence of the same DRP. The most frequent index DRPs were constipation (14.2%), gastrointestinal bleeding (9.2%), hypertension (8.3%), seizures (8.3%) and hyponatraemia (6.7%). An age ≥ 80 years independently predicted fewer 30-day DRP revisits (OR 0.32; 95% CI 0.13–0.79); hypertension and cognitive impairment were not significant after adjustment. Conclusions: In this single-arm implementation cohort, overall, 30-day ED reconsultations were 9.6% and about one-third were DRP-related, predominantly recurrences, and chiefly gastrointestinal bleeding and seizures. These descriptive findings should be interpreted cautiously given potential survivorship bias and residual confounding; the apparently lower risk among patients aged ≥ 80 years is hypothesis-generating and may reflect geriatric care pathways and caregiver engagement. Targeted post-discharge monitoring for high-recurrence DRPs may help reduce avoidable ED use, and future evaluations should test this in quasi-experimental or randomized designs.

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