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Published on: December 11, 2016
Drug-related risk of hospital readmission in children with chronic diseases, a systematic review
Elham Jaberi1, Behrouz Kassai2, Anick Berard3
1UMR CNRS 5558, Laboratoire de Biométrie et Biologie Humaine, Équipe Évaluation et Modélisation des Effets Thérapeutiques, 69376 Lyon, France.
Insights
Drug-related problems (DRPs) significantly impact hospital readmissions in children with chronic diseases, though results are conflicting. More research is needed to reduce bias and clarify these associations.
Area of Science:
- Pediatric Health
- Pharmacovigilance
- Health Services Research
Background:
- Drug-related problems (DRPs) are a major cause of hospital readmissions, particularly in children with chronic conditions.
- The specific burden and characteristics of DRPs leading to readmission in pediatric populations are not well understood.
Purpose of the Study:
- To systematically review and summarize the impact of DRPs at and after hospital discharge on readmission risk in children with chronic diseases.
Main Methods:
- A systematic review of PubMed (inception–January 2022) was conducted.
- Studies assessing DRPs' impact on pediatric readmissions, with or without other factors, were included.
- Risk of Bias in Non-Randomized Studies - of Exposure (ROBINS-E) tool assessed study quality.
Main Results:
- Thirteen studies were included, mostly retrospective analyses of electronic health records.
- DRPs assessed included medication type, quantity, and nonadherence.
- Of 44 associations, 59% were conclusive, with most increasing readmission risk; 39% were inconclusive.
Conclusions:
- The association between DRPs and hospital readmissions in children with chronic diseases shows conflicting results.
- Estimated associations may carry a serious risk of bias.
- Further high-quality evidence with a lower risk of bias is required.
Background:
Drug-related problems (DRPs) are one of the leading causes of hospital readmissions. Children with chronic diseases are more likely to experience DRPs than adults. The burden and characteristics of drug-related readmissions at and after hospital discharge in children remain unclear.
Objective:
We aimed to summarize the impact of DRPs at and after hospital discharge on the risk of readmissions in children with chronic diseases.
Methods:
We conducted a systematic review searching PubMed from inception until January 2022. Study selection criteria were studies assessing the impact of different factors at discharge and after discharge on the risk of hospital readmissions in children with chronic diseases, reporting an assessment of DRPs. DRP could be the only risk factor assessed or one among others. Included studies were assessed with the Risk of Bias in Non-Randomized Studies - of Exposure (ROBINS-E) tool. We summarized the qualitative impact of the reported DRPs on hospital readmission as conclusive (significant association) or inconclusive.
Results:
Of the 4734 studies initially identified, 13 met inclusion criteria. Eleven studies were retrospective, using electronic health records. The studies assessed the impact of DRPs at or after discharge according to the type of medication (in 6 studies), number of medication (in 5 studies) and medication nonadherence (in 2 studies). From the 44 reported associations between DRPs and the risk of readmission 26 (59% [95% CI, 43%-73%]) were conclusive, of which 81% increased the risk and 19% decreased the risk, and 17 (39% [95% CI, 24%-55%]) were inconclusive.
Conclusion:
The impact of DRPs on hospital readmissions in children with chronic diseases displayed conflicting results, estimated associations having potentially a serious risk of bias. We need more evidence with a lower risk of bias.
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