Proportion of patients admitted to rural and remote hospitals that experience a 30-day medication-related readmission: a retrospective cohort study.

Abstract

Introduction: Medication-related readmissions are a significant and preventable cause of patient harm. Patients living in rural and remote areas may face inequitable access to healthcare and fragmented continuity of care, increasing their vulnerability to medication-related harm. Despite this, the burden and drivers of medication-related readmissions in these settings remain poorly understood. Determining the current burden and identifying factors associated with medication-related readmissions is essential to inform targeted strategies to improve medication safety.

Aim: To determine the proportion of adult patients with a medication-related readmission within 30 days of discharge from rural and remote hospitals, and to identify factors potentially associated with these readmissions.

Method: A retrospective cohort study was conducted using medical records of adults admitted to rural and remote hospitals in New South Wales, Australia, between June 1, 2022 and August 31, 2023. Readmissions within 30 days were assessed for medication-related causes using the AT-HARM10, a validated 10-item tool based on admission notes, medication lists, inpatient pathology results, and discharge summaries. Patient demographics, comorbidities and admission details were extracted. Comorbidity burden was calculated using the Charlson Comorbidity Index (CCI). Medication lists were based on medications charted 12 h before discharge. Univariable logistic regression was performed to explore factors associated with 30-day medication-related readmissions, with results reported as unadjusted odds ratios (uOR).

Results: Of the 2220 patients admitted during the study period, 6% (n = 133) experienced a 30-day readmission, of which 22.5% (n = 30) were medication-related. Overall, 1.4% of all admitted patients experienced a 30-day medication-related readmission. Older age (uOR 1.04; 95% CI 1.01-1.07), higher CCI (uOR 1.22; 95% CI 1.04-1.44), a greater number of regular medications (uOR 1.07 per additional medication; 95% CI 1.01-1.14), and insulin use (uOR 2.80; 95% CI 1.06-7.42) were associated with medication-related readmission.

Conclusion: In rural and remote hospitals, a small but clinically important proportion of patients experienced a medication-related readmission within 30 days of discharge. Unadjusted analysis identified that older age, multimorbidity, polypharmacy and insulin use were associated with increased risk. Larger studies are needed to validate these findings and evaluate strategies to reduce medication-related harm in rural and remote populations.