The Impact of Drug Burden Index on Unplanned Hospital Readmission and Length of Hospital Stay

Mohanad Odeh — 2022-04-20

Background: The Drug Burden Index (DBI) is a pharmacotherapy risk assessment tool explored to evaluate its association with unplanned hospital-related outcomes.
Objective: To evaluate the DBI association with unplanned hospital readmissions, develop a prediction model for unplanned readmissions. To investigate DBI association with length of hospital stay (LOS).
Setting: Unplanned readmission data were collected for 1000 adult hospitalized patients at Antrim Area Hospital in Northern Ireland.
Method: The study was designed as a retrospective analysis. Logistic regression models were developed to determine the prediction power. Discriminative ability testing was carried out using the Receiver Operating Characteristic (ROC) curve. Youden's index formula was used to detect the cut-off points. Analysis of covariance (ANCOVA) was performed to determine whether LOS differed based on the DBI score. Finally, negative binomial regression was used to predict LOS based on DBI.
Results: Of the 1000 patient records, 43% were females, and a total of 885 (88.5%) were exposed to sedative and anticholinergic medications (DBI>0). Readmission rates at 7, 14, 30 and 90 days were 5.4%, 9.0%, 15.0% and 28.8% respectively. The odds ratio (OR) of readmission within seven days for patients with DBI>1 was 3.42 times higher than those who had their DBI=0 (OR= 3.42, 95% CI: 1.6–7.3; P= 0.001). The DBI category significantly predicts 7-day readmission (P=0.002), the area under the curve for the ROC curve was 0.65 (95% CI: 0.58 - 0.71; P<0.001). For 14-day readmissions, patients with a DBI >1, compared with DBI=0, had a reported higher Odds Ratio (OR = 2.19, 95% CI: 1.1– 4.4; P= 0.025). However, the DBI category prediction power for 14-day readmission was not significant (P=0.069). DBI failed to show an association with 30- and 90-day readmissions. The adjusted estimated marginal difference for LOS of patients with DBI>1 vs. DBI=0 was 2.7 (95%CI: 0.89 – 4.5; P=0.003).
Conclusion: DBI was a statistically significant tool to predict 7-days unplanned readmission. DBI was not a statistically significant predictor for readmission over longer periods. Higher DBI was associated with a longer LOS.
Impact on Practice Statements: Readmission within seven days of a patient's discharge can be predicted by the DBI, and a longer hospital stay was also associated with higher DBI. Accordingly, the hospital teams can consider reporting DBI scores and performing tailored discharge plans for patients who are at risk for seven days of unplanned readmission.

Perception, Barriers and Acceptance of COVID 19 Vaccination in Surgical Patients: A Single Centre Study

Akaninyene Dan — 2022-03-18

Background: The COVID-19 vaccination programme has been one of the most important measures to reduce spread and severity of COVID-19 infection. However, acceptance of the vaccine has met with challenges due to the speed of its development and concerns about side-effects. The aim of this study was to assess knowledge of the vaccination as well as barriers to acceptance and the overall impact of the vaccination on personal protective behaviors of surgical patients.
Method: In this cross-sectional study, a self-completed questionnaire was given to inpatients on all general surgery wards at a district general hospital between April and May 2021. Participation was voluntary. The questionnaire was designed to assess participant knowledge of and adherence to the COVID-19 vaccination programme as well as to understand participants views on other protective measures to prevent and reduce COVID-19 infection. Approximately 200-300 patients are admitted to our department monthly.
Results: A total of 202 respondents participated in the study, males comprised 29.2% of the individuals surveyed. The majority of the patients were over 40 years old (68.3%). All the participants were aware of the vaccine, and the government sensitization material was the most common source of information (37.9%).
The majority of individuals surveyed (79.7%) had received at least one dose of the vaccine. In the unvaccinated patients, 33 participants reported not being offered the vaccine while 4 patients stated that they do not believe in the vaccine.
Conclusion: The study demonstrated that the majority of the patients surveyed were quite familiar with the vaccines and were willing to participate in the vaccination program. However, the knowledge of the vaccine and its adverse effects would best be described as inadequate. Also, participants were largely aware of the measures put in place to curb the spread of the virus and did show a good level of compliance guidance.

Advances in Pharmaceutical Sciences

The Impact of Drug Burden Index on Unplanned Hospital Readmission and Length of Hospital Stay

Perception, Barriers and Acceptance of COVID 19 Vaccination in Surgical Patients: A Single Centre Study