Aim: This study aimed to evaluate the PHarmacie-R risk prediction tool in predicting medication-related harm (MRH) in older adults receiving GEM at Home care, and in predicting unplanned hospital readmissions within 90-days of discharge from the service.
Method: A retrospective observational study included 208 patients consecutively admitted to GEM at Home between 1 February and 10 October 2023. Patient characteristics, MRH incidents, and unplanned 90-day readmissions were examined. The PHarmacie-R tool incorporated into a smartphone app, used routinely collected patient demographics, social, and clinical variables to generate a binary risk outcome, with scores >0.4 indicating high risk of MRH or readmission and scores ≤0.4 indicating low risk. PHarmacie-R predicted risk was retrospectively evaluated against documented MRH and readmissions using C-statistics, sensitivity, specificity, positive and negative predictive values.
Results: Among 208 patients (median age 82 years), 90.9% had polypharmacy and 71.2% were prescribed at least one HRM. MRH occurred in 38 patients (18.3%), with 55 incidents identified. Most patients experienced a single incident (n=28), while ten had multiple incidents. Two MRH incidents were classified as probable, non-preventable adverse drug reactions. Unplanned hospital readmission within 90 days occurred in 91 patients (43.8%). PHarmacie-R demonstrated modest discrimination for MRH (C-statistic 0.620) and poor discrimination for 90-day readmission (C-statistic 0.556).
Conclusion: PHarmacie-R tool showed poor to modest accuracy in predicting MRH and unplanned hospital readmission in a GEM at Home population. Further research is required to determine whether population-specific algorithms with tailored weighting of key variables could improve usability in this setting.