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Are Lists of Potentially Inappropriate Medications Associated with Hospital Readmissions? A Systematic Review

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Abstract

Background

Suboptimal prescribing, including the prescription of potentially inappropriate medications (PIM), is frequent in patients aged 65 years and older. PIMs are associated with adverse drug events, which may lead to hospital admissions and readmissions for the most serious cases. Several tools, known as lists of PIMs, can detect suboptimal prescription.

Objective

This systematic review aimed to identify which lists of PIMs are associated with hospital readmission of older patients.

Patients and Methods

MEDLINE, the Cochrane Library, EMBASE, and clinicaltrials.gov were searched for the period from 1 January 1991 up to 12 May 2022 to identify original studies assessing the association between PIMs and hospital readmissions or emergency department (ED) revisits within 30 days of discharge in older patients. This study is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Checklist, and the risk of bias was assessed with the Newcastle–Ottawa Quality Assessment Scale for Cohort Studies (NOS) and the revised Cochrane risk-of-bias tool for randomized trials (RoB 2).

Results

A total of six studies presenting four different lists of PIMs were included. Readmission rates varied from 4.3 to 25.5% and the odds ratio (OR) between PIMs and hospital readmission varied from 0.92 [95% confidence interval (CI) 0.59; 1.42] to 6.48 [95% CI 3.00; 14.00]. Only two studies found a statistically significant association between a list of PIMs and hospital readmission. These two studies used different tools: the Screening Tool of Older Person’s Prescriptions (STOPP) and the Screening Tool to Alert Doctors to Right Treatment (START) and a combination of Beers Criteria® and STOPP and START.

Conclusion

This systematic review shows that the association between list of PIMs and 30-day unplanned readmissions remains unclear and seems dependent on the PIM detection tool. Further studies are needed to clarify this association.

PROSPERO registration number CRD42021252107.

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Acknowledgments

The authors would like to acknowledge Stella Ghouti for the correction of the manuscript.

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Authors and Affiliations

  1. Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, 75012, Pharmacie, Paris, France

    Camille Schwab, Christine Fernandez & Patrick Hindlet

  2. Université Paris Saclay, Faculté de Pharmacie, Département de Pharmacie clinique, Orsay, France

    Camille Schwab, Alice Clementz, Christine Fernandez & Patrick Hindlet

  3. Assistance Publique-Hôpitaux de Paris, Hôpital Sainte-Périne, Pharmacie, Paris, France

    Alice Clementz

  4. Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France

    Agnès Dechartres

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Correspondence to Camille Schwab.

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Substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data: Camille Schwab, Alice Clementz, Patrick Hindlet, and Agnès Dechartres. Drafting the article or revising it critically for important intellectual content: Camille Schwab, Alice Clementz, Patrick Hindlet, and Christine Fernandez. Final approval of the version to be published: Agnès Dechartres, Christine Fernandez, and Patrick Hindlet. Sponsor’s role: none. All authors have read and approved the final version of the manuscript, and agree to be accountable for the work.

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Schwab, C., Clementz, A., Dechartres, A. et al. Are Lists of Potentially Inappropriate Medications Associated with Hospital Readmissions? A Systematic Review. Drugs Aging 41, 209–218 (2024). https://doi.org/10.1007/s40266-024-01099-9

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