Medication-related characteristics of a high-utilizer psychiatric population

To identify medication-related and nonmedication-related characteristics and risk factors for readmission in a high-utilizer psychiatric population.

In this retrospective cohort study, patients were identified through the institution's electronic medical records as high utilizers if they had 5 or more psychiatric admissions or at least 1 30-day psychiatric readmission from July 2012 through March 2014. The primary outcome was to identify medication-related characteristics. Secondary outcomes were to identify if medication- and nonmedication-related factors were related to number of and time to readmissions.

A total of 170 patients and 497 readmissions were included. Up to 89% of patients had 30-day readmissions, and 12% had 5 or more readmissions. A total of 52% of patients were discharged on 6 or more medications, with 54% discharged with at least 3 psychotropic medications. A total of 31% of patients had documented medication nonadherence, with adverse effects or cost reported as the most common reasons. Only 32% of patients filled a prescription at the hospital's outpatient pharmacy with 44% doing so within 7 days of discharge. Adherence and use of outpatient pharmacy were unrelated to the number of readmissions and time to readmission, but having a diagnosis of major depressive disorder was related to shorter time to readmission.

Low outpatient pharmacy utilization, multiple psychotropic discharge medications, and unknown or documented nonadherence are common traits of this population. Future studies to determine what medication factors influence readmissions and whether targeting those specific medication-related factors would decrease the risk for readmission are needed.