246620e94fca623a71a960276290622c jcm-14-06907.pdf e8cdcc0b5b8de3b152500a0fcd8bd250a887d1d7 jcm-14-06907.pdf b933491540c041bdea0baf64c3fdb19ea5ff50516f3bce19babe2b2c512a8ca7 jcm-14-06907.pdf Title: Emergency Department Reconsultations After a Secondary Prevention Bundle for Medication-Related Problems: A Retrospective Cohort Study Subject: Background/Objective: Drug-related problems (DRPs) are a common, potentially avoidable cause of emergency department (ED) use. In December 2022, our hospital integrated a pharmacist-led intervention into routine ED practice. This intervention comprised medication optimization, adherence counseling, and coordinated hand-off to primary care. We quantified 30- and 90-day reconsultations after discharge and explored factors associated with DRP-related revisits. Methods: A retrospective cohort of adults (18 years) who attended a tertiary ED (Barcelona, Spain). We included index DRP visits from 1 December 2022 to 30 June 2024. All received the bundle. Demographic, clinical, and pharmacotherapeutic data were extracted from the Catalan Shared Health Record; an independent committee classified revisits as a DRP or non-DRP. Predictors of 30-day DRP revisits were assessed with multivariable logistic regression. Results: Among 1247 patients (mean age 78.6 16.2 years; 59.2% women; and median nine drugs), 120 (9.6%) reconsulted the ED within 30 days, and 194 (15.5%) within 90 days for any cause. DRP-specific rates were 30.8% (37/120) at 30 days and 26.3% (51/194) at 90 days; 81% and 80% of these revisits, respectively, involved a recurrence of the same DRP. The most frequent index DRPs were constipation (14.2%), gastrointestinal bleeding (9.2%), hypertension (8.3%), seizures (8.3%) and hyponatraemia (6.7%). An age 80 years independently predicted fewer 30-day DRP revisits (OR 0.32; 95% CI 0.13–0.79); hypertension and cognitive impairment were not significant after adjustment. Conclusions: In this single-arm implementation cohort, overall, 30-day ED reconsultations were 9.6% and about one-third were DRP-related, predominantly recurrences, and chiefly gastrointestinal bleeding and seizures. These descriptive findings should be interpreted cautiously given potential survivorship bias and residual confounding; the apparently lower risk among patients aged 80 years is hypothesis-generating and may reflect geriatric care pathways and caregiver engagement. Targeted post-discharge monitoring for high-recurrence DRPs may help reduce avoidable ED use, and future evaluations should test this in quasi-experimental or randomized designs. Keywords: drug-related problems; emergency department; secondary prevention; readmission; older adults Author: Adrián Plaza-Díaz, Ana Juanes-Borrego, Natalia Sanz-Lopez, Javier González-Bueno, Jordi Fernández-Morató, Milagros García-Peláez and Jesús Ruiz-Ramos Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Mon Sep 29 15:01:02 2025 CEST ModDate: Mon Sep 29 15:13:14 2025 CEST Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 10 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 511379 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- JGMOZW+CMSY10 Type 1 Builtin yes yes yes 98 0 MDJAWW+URWPalladioL-Roma Type 1 Custom yes yes yes 99 0 FNSQWZ+VnURWPalladioL Type 1 Custom yes yes yes 100 0 UBBMRV+URWPalladioL-Ital Type 1 Custom yes yes yes 101 0 MMSBNO+URWPalladioL-Bold Type 1 Custom yes yes yes 102 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 181 0 KMGAPK+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 175 0 KMGAOJ+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 176 0 KMGAPJ+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 177 0 KMGAPK+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 192 0 KMGAOJ+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 193 0 KMGAPJ+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 194 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-12-19 03:10:02 CET RepresentationInformation: jcm-14-06907.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-12-18 14:38:06 CET Size: 511379 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 314 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Item: Title: Materials and Methods Children: Item: Title: Study Design Item: Title: Intervention Children: Item: Title: Optimizing Long-Term Medication Item: Title: Enhancing Adherence Item: Title: Strengthening Care Coordination Item: Title: Statistical Analysis Item: Title: Results Children: Item: Title: Index and Recurrent DRP Item: Title: Predictors of 30-Day DRP Revisits Item: Title: 90-Day ED Reconsultations and DRP Recurrence Item: Title: Discussion Item: Title: References Info: Title: Emergency Department Reconsultations After a Secondary Prevention Bundle for Medication-Related Problems: A Retrospective Cohort Study Author: Adrián Plaza-Díaz, Ana Juanes-Borrego, Natalia Sanz-Lopez, Javier González-Bueno, Jordi Fernández-Morató, Milagros García-Peláez and Jesús Ruiz-Ramos Subject: Background/Objective: Drug-related problems (DRPs) are a common, potentially avoidable cause of emergency department (ED) use. In December 2022, our hospital integrated a pharmacist-led intervention into routine ED practice. This intervention comprised medication optimization, adherence counseling, and coordinated hand-off to primary care. We quantified 30- and 90-day reconsultations after discharge and explored factors associated with DRP-related revisits. Methods: A retrospective cohort of adults (18 years) who attended a tertiary ED (Barcelona, Spain). We included index DRP visits from 1 December 2022 to 30 June 2024. All received the bundle. Demographic, clinical, and pharmacotherapeutic data were extracted from the Catalan Shared Health Record; an independent committee classified revisits as a DRP or non-DRP. Predictors of 30-day DRP revisits were assessed with multivariable logistic regression. Results: Among 1247 patients (mean age 78.6 16.2 years; 59.2% women; and median nine drugs), 120 (9.6%) reconsulted the ED within 30 days, and 194 (15.5%) within 90 days for any cause. DRP-specific rates were 30.8% (37/120) at 30 days and 26.3% (51/194) at 90 days; 81% and 80% of these revisits, respectively, involved a recurrence of the same DRP. The most frequent index DRPs were constipation (14.2%), gastrointestinal bleeding (9.2%), hypertension (8.3%), seizures (8.3%) and hyponatraemia (6.7%). An age 80 years independently predicted fewer 30-day DRP revisits (OR 0.32; 95% CI 0.13–0.79); hypertension and cognitive impairment were not significant after adjustment. Conclusions: In this single-arm implementation cohort, overall, 30-day ED reconsultations were 9.6% and about one-third were DRP-related, predominantly recurrences, and chiefly gastrointestinal bleeding and seizures. These descriptive findings should be interpreted cautiously given potential survivorship bias and residual confounding; the apparently lower risk among patients aged 80 years is hypothesis-generating and may reflect geriatric care pathways and caregiver engagement. Targeted post-discharge monitoring for high-recurrence DRPs may help reduce avoidable ED use, and future evaluations should test this in quasi-experimental or randomized designs. 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