Affiliation:
1. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts USA
2. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center Center for Anesthesia Research Excellence (CARE) Boston Massachusetts USA
3. Department of Pharmacy Beth Israel Deaconess Medical Center Boston Massachusetts USA
Abstract
AbstractBackgroundPatients newly initiated on opioids (OP), benzodiazepines (BZD), and antipsychotics (AP) during hospitalization are often prescribed these on discharge. Implications of this practice on outcomes remains unexplored.ObjectiveTo explore the prevalence and risk factors of new initiation of select OP, BZD and AP among patients requiring in‐patient stays. Test the hypothesis that new prescriptions are associated with higher odds of readmission or death within 28 days of discharge.DesignSingle center retrospective cohort study.Setting and ParticipantsPatients admitted to a tertiary‐level medical center with either a primary diagnosis of RT‐PCR positive for COVID‐19 or high index of clinical suspicion thereof.InterventionNone.Main Outcome and MeasuresExposure was the new initiation of select common OP, BZD, and AP which were continued on hospital discharge. Outcome was a composite of 28‐day readmission or death following index admission. Multivariable logistic regression was used to assess patient mortality or readmission within 28 days of discharge associated with new prescriptions at discharge.ResultsOne thousand three hundred and nineteen patients were included in the analysis. 11.3% (149/1319) were discharged with a new prescription of select OP, BZD, or AP either alone or in combination. OP (110/149) were most prescribed followed by BZD (41/149) and AP (22/149). After adjusting for unbalanced confounders, new prescriptions (adjusted odds ratio: 2.44, 95% confidence interval: 1.42‐4.12; p = .001) were associated with readmission or death within 28 days of discharge. One in nine patients admitted with a diagnosis of COVID‐19 or high clinical suspicion thereof were discharged with a new prescription of either OP, BZD or AP. New prescriptions were associated with higher odds of 28‐day readmission or death. Strengthening medication reconciliation processes focused on these classes may reduce avoidable harm.