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Potentially harmful medication dispenses after a fall or hip fracture
A mixed methods study of a commonly used quality measure
Fischer, H., Hahn, E. E., Li, B. H., Munoz-Plaza, C. E., Luong, T. Q., Harrison, T. N., Slezak, J. M., Sim, J. J., Mittman, B. S., Lee, E. A., Singh, H., Kanter, M. H., Reynolds, K., & Danforth, K. N. (2022). Potentially harmful medication dispenses after a fall or hip fracture: A mixed methods study of a commonly used quality measure. Joint Commission Journal on Quality and Patient Safety, 48(4), 222-232. https://doi.org/10.1016/j.jcjq.2022.01.003
BACKGROUND: High-risk medication dispenses to patients with a prior fall or hip fracture represent a potentially dangerous disease-drug interaction among older adults. The research team quantified the prevalence, identified risk factors, and generated patient and provider insights into high-risk medication dispenses in a large, community-based integrated health system using a commonly used quality measure.
METHODS: This was a mixed methods study with a convergent design combining a retrospective cohort study using electronic health record (EHR) data, individual interviews of primary care physicians, and a focus group of patient advisors.
RESULTS: Of 113,809 patients ≥ 65 years with a fall/fracture in 2009-2015, 35.4% had a potentially harmful medication dispensed after their fall/fracture. Most medications were prescribed by primary care providers. Older age, male gender, and race/ethnicity other than non-Hispanic White were associated with a reduced risk of high-risk medication dispenses. Patients with a pre-fall/fracture medication dispense were substantially more likely to have a post-fall/fracture medication dispense (hazard ratio [HR] = 13.26, 95% confidence interval [CI] = 12.91-13.61). Both patients and providers noted that providers may be unaware of patient falls due to inconsistent assessments and patient reluctance to disclose falls. Providers also noted the lack of a standard location to document falls and limited decision support alerts within the EHR.
CONCLUSION: High-risk medication dispenses are common among older patients with a history of falls/fractures. Future interventions should explore improved assessment and documentation of falls, decision support, clinician training strategies, patient educational resources, building trusting patient-clinician relationships to facilitate long-term medication discontinuation among persistent medication users, and a focus on fall prevention.
