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Multicenter Study
. 2022 Jan 7;26(1):6.
doi: 10.1186/s13054-021-03848-3.

Association between unmet medication needs after hospital discharge and readmission or death among acute respiratory failure survivors: the addressing post-intensive care syndrome (APICS-01) multicenter prospective cohort study

Samuel M Brown  1   2   3   4 , Victor D Dinglas  5 , Narjes Akhlaghi  6 , Somnath Bose  7 , Valerie Banner-Goodspeed  7 , Sarah Beesley  8   9   10 , Danielle Groat  8   10 , Tom Greene  11 , Ramona O Hopkins  10   12 , Mustafa Mir-Kasimov  9   13 , Carla M Sevin  14 , Alison E Turnbull  5 , James C Jackson  14 , Dale M Needham  5 ; APICS-01 Study Team
Collaborators, Affiliations
Multicenter Study

Association between unmet medication needs after hospital discharge and readmission or death among acute respiratory failure survivors: the addressing post-intensive care syndrome (APICS-01) multicenter prospective cohort study

Samuel M Brown et al. Crit Care. .

Abstract

Introduction: Survivors of acute respiratory failure (ARF) commonly experience long-lasting physical, cognitive, and/or mental health impairments. Unmet medication needs occurring immediately after hospital discharge may have an important effect on subsequent recovery.

Methods and analysis: In this multicenter prospective cohort study, we enrolled ARF survivors who were discharged directly home from their acute care hospitalization. The primary exposure was unmet medication needs. The primary outcome was hospital readmission or death within 3 months after discharge. We performed a propensity score analysis, using inverse probability weighting for the primary exposure, to evaluate the exposure-outcome association, with an a priori sample size of 200 ARF survivors.

Results: We enrolled 200 ARF survivors, of whom 107 (53%) were female and 77 (39%) were people of color. Median (IQR) age was 55 (43-66) years, APACHE II score 20 (15-26) points, and hospital length of stay 14 (9-21) days. Of the 200 participants, 195 (98%) were in the analytic cohort. One hundred fourteen (57%) patients had at least one unmet medication need; the proportion of medication needs that were unmet was 6% (0-15%). Fifty-six (29%) patients were readmitted or died by 3 months; 10 (5%) died within 3 months. Unmet needs were not associated (risk ratio 1.25; 95% CI 0.75-2.1) with hospital readmission or death, although a higher proportion of unmet needs may have been associated with increased hospital readmission (risk ratio 1.7; 95% CI 0.96-3.1) and decreased mortality (risk ratio 0.13; 95% CI 0.02-0.99).

Discussion: Unmet medication needs are common among survivors of acute respiratory failure shortly after discharge home. The association of unmet medication needs with 3-month readmission and mortality is complex and requires additional investigation to inform clinical trials of interventions to reduce unmet medication needs. Study registration number: NCT03738774 . The study was prospectively registered before enrollment of the first patient.

Keywords: Acute respiratory failure; Discharge planning; Health services research; Long-term outcomes.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig. 1
Fig. 1
Flow diagram of patient participation in APICS-01
Fig. 2
Fig. 2
Kaplan–Meier curves for combined readmission and mortality; grouped by proportion of unmet medication needs
See this image and copyright information in PMC

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