Pharmacoepidemiology · Published 2025-01-01 · Journal article · DOI 10.3390/pharma5020017
Background/Objectives: Medication discrepancies at hospital discharge are common and may contribute to adverse drug events and avoidable healthcare use. Patients with mental health conditions may be at increased risk because of greater clinical complexity, polypharmacy, and fragmented care, but comparative evidence during general hospital admissions is limited. Our primary objective was to determine whether adults with mental health conditions were more likely than those without such conditions to experience unintended medication discrepancies at hospital discharge. Secondary objectives were to examine discrepancy subtypes, assess whether associations differed for serious mental illness versus other mental health conditions, and explore whether associations varied by reconciliation arm. Methods: We conducted a retrospective cohort study using linked data from the RightRx cluster-randomized trial at the McGill University Health Centre (2014–2016) and Quebec administrative databases. Adults with continuous provincial drug coverage for at least 12 months before admission who met study eligibility criteria were included. The primary exposure was any documented mental health condition; secondary analyses distinguished serious mental illness (SMI) from other mental health conditions. The primary outcome was any unintended medication discrepancy at discharge; subtype analyses examined omissions, therapeutic duplications, and unintended dose changes. Results: Among 3567 patients, 877 (24.6%) had a mental health condition. Crude discrepancy prevalence was similar between groups. In the prespecified primary analysis, mental health condition status was associated with lower observed odds of any unintended discrepancy at discharge. This unexpected inverse association should not be interpreted as evidence of a protective effect and may reflect differences in documentation, residual confounding, selection, or other unmeasured processes. Secondary and supplementary analyses, including omission and SMI subgroup comparisons, did not remain statistically significant after Holm correction. Conclusions: These findings suggest that documentation-based discrepancy measures may relate to mental health status in heterogeneous ways, but they require confirmation in independent settings.
Abstract from DOAJ. Public domain (CC0 1.0).
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