Medication complexity and COVID-19 pandemic impact on the cost burden in non-COVID elderly patients at the emergency department

Authors

DOI:

https://doi.org/10.46542/pe.2023.234.264268

Keywords:

Charge, Economic, MRCI, Older adult, Therapy

Abstract

Background: The global increase in the elderly population and the incidence of emergency conditions due to physiological changes pose cost challenges for emergency services. COVID-19 potentially affects the financial burden of medication in elderly patients.    

Objective: To analyse the impact of medication complexity on the cost burden in elderly patients admitted to the Emergency Department (ED) before and during the COVID-19 pandemic.    

Method: A retrospective observational study was conducted among elderly patients (aged > 60 years) who visited ED but were not hospitalised between January to April 2020. The medication complexity was measured using the Medication Regimen Complexity Index (MRCI) while the cost was collected from the hospital information system.    

Result: A total of 321 ED visits were included in this study. The results showed that the mean of the total medication was 3.89 ± 1.70, while the mean score of the MRCI was 15.20 ± 6.54. The mean medication cost required was IDR 56,342 for each ED visit.    

Conclusion: This study provided an overview and input to control medication costs for elderly patients in the emergency setting. Interested parties can design policies that are beneficial in economics and therapeutic outcomes.

Author Biographies

Khusnul Fitri Hamidah, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia

Department of Pharmacy

Mahardian Rahmadi, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia

Department of Pharmacy Practice

Erfan Abdissalam, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia & Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia

Department of Pharmacy

Indah Septiani, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia

Department of Pharmacy

Febriansyah Nur Utomo, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia

Department of Pharmacy

Wieka Rafelina Batubara, Hajj General Hospital, Surabaya, Indonesia

Department of Pharmacy

References

Akazawa, M., Imai, H., Igarashi, A., & Tsutani, K. (2010). Potentially inappropriate medication use in elderly Japanese patients. The American Journal of Geriatric Pharmacotherapy, 8(2), 146–160. https://www.doi.10.1016/j.amjopharm.2010.03.005

Alvis, B. D., & Hughes, C.G. (2015). Physiology considerations in geriatric patients. Anesthesiology clinics, 33(3), 447–456. https://www.doi/10.1016/j.anclin.2015.05.003

Asmarawati, T.P., Rosyid, A.N., Suryantoro, S.D., Mahdi, B.A., Windradi, C., Wulaningrum, P.A., Arifijanto, M.A., Bramantono, B., Triyono, E.A., Rusli, M., Rachman, B.E., Marfiani, E., Endraswari, P.D., Hadi, U., Kuntaman, K., & Nasronudin, N. (2021). The clinical impact of bacterial co-Infection among moderate, severe, and critically ill Covid-19 patients in seconds referral hospital in Surabaya. F1000 Research, 10(113), 1-16. https://www.doi/10.12688/f1000research.31645.2

Brysch, E.G., Cauthon, K.A.B., Kalich, B.A., & Sarbacker, G.B. (2018). Medication regimen complexity index in the elderly in an outpatient setting: A literature review. The consultant pharmacist, 33(9), 484-496. https://www.doi/10.4140/TCP.n.2018.484

Gedmintas, A., Bost, N., Keijzers, G., Green, D., & Lind, J. (2010). Emergency care workload units: A novel tool to compare emergency department activity. Emergency medicine Australasia: EMA, 22(5), 442–448. https://www.doi/10.1111/j.1742-6723.2010.01322.x

Hajjar, E.R., Hanlon, J.T., Sloane, R.J., Lindblad, C.I., Pieper, C.F., Ruby, C.M., & Schmader, K.E. (2005). Unnecessary drug use in frail older people at hospital discharge. Journal of the American Geriatrics Society, 53(9), 1518–1523. https://www.doi/10.1111/j.1532-5415.2005.53523.x

Harding, A.M., Welton, C.G., & Yeoh, M.J. (2015). Medication costs in an emergency department. Journal of Pharmacy Practice and Research, 45(4), 419–422. https://doi.org/10.1002/jppr.1159

Hartnett, K.P., Kite-Powell, A., DeVies, J., Coletta, M.A., Boehmer, T.K., Adjemian, J., Gundlapalli, A.V., & National Syndromic Surveillance Program Community of Practice (2020). Impact of the COVID-19 pandemic on emergency department visits - United States, January 1, 2019-May 30, 2020. MMWR. Morbidity and mortality weekly report, 69(23), 699–704. https://doi.org/10.15585/mmwr.mm6923e1

Hirsch, J.D., Metz, K.R., Hosokawa, P.W., & Libby, A.M. (2014). Validation of a patient-level medication regimen complexity index as a possible tool to identify patients for medication therapy management intervention. Pharmacotherapy, 34(8), 826–835. https://doi.org/10.1002/phar.1452

Indonesia Central Statistics Agency. (2020). Statistik Penduduk Usia Lanjut 2020. Jakarta: Indonesia Central Statistics Agency.

Lumjeaksuwan, M., Suparada P., Chanatip S., Natchaya S., Apichat A., & Borwon W. (2022). The trend of emergency department visits among the elderly in Thailand. WHO South-East Asia J Public Health, 10(1), 1-4. https://doi.org/10.4103/WHO-SEAJPH.WHO-SEAJPH_67_21

Mancini, D.J. & Allen, S. (2018). Geriatric physiology. New York: Springer International Publishing.

Masumoto, S., Sato, M., Momo, K., Matsushita, A., Suzuki, K., Shimamura, H., & Hamano, J. (2020). Development of medication regimen complexity index: Japanese version and application in elderly patients. International Journal of Clinical Pharmacy, 43(4), 858-863. https://doi.org/10.1007/s11096-020-01185-z

Miethke-Morais, A., Cassenote, A., Piva, H., Tokunaga, E., Cobello, V., Rodrigues Gonçalves, F.A., Dos Santos Lobo, R., Trindade, E., Carneiro D Albuquerque, L.A., Haddad, L. & HCFMUSP Covid-19 Study Group (2021). COVID-19-related hospital cost-outcome analysis: The impact of clinical and demographic factors. The Brazilian Journal of Infectious Diseases: An official publication of the Brazilian Society of Infectious Diseases, 25(4), 101609. https://doi.org/10.1016/j.bjid.2021.101609

Miljkovic, M., Dragojevic-Simic, V., Rancic, N., Simic, R., Pekez-Pavlisko, T., Kovacevic, A., & Stamenkovic, D. (2018). Metamizole utilization and expenditure during 6-year period: Serbia vs. Croatia. Frontiers in Public Health, 6, 213 https://doi.org/10.3389%2Ffpubh.2018.00213

Morrow, J. & Laher, A.E. (2022). Financial burden associated with attendance at a public hospital emergency department in Johannesburg. African journal of emergency medicine: Revue africaine de la médecine d'urgence, 12(2), 102–105. https://doi.org/10.1016/j.afjem.2022.02.002

Samaras, N., Chevalley, T., Samaras, D., & Gold, G. (2010). Older patients in the emergency department: A review. Annals of emergency medicine, 56(3), 261–269. https://doi.org/10.1016/j.annemergmed.2010.04.015

Sevilla-Sanchez, D., Molist-Brunet, N., González-Bueno, J., Solà-Bonada, N., Amblàs-Novellas, J., Espaulella-Panicot, J. & Codina-Jane, C. (2019). Medication regimen complexity on hospital admission in patients with advanced chronic conditions in need of palliative care. European Journal of Hospital Pharmacy: Science and Practice, 26(5), 262–267. https://doi.org/10.1136/ejhpharm-2017-001478

Sun R, Karaca Z. & Wong HS (2018). Trends in hospital emergency department visits by age and payer, 2006–2015. 2018 Mar. In Healthcare cost and utilization project (HCUP) statistical briefs. Agency for Healthcare Research and Quality (US): 2006 Feb. Statistical Brief #238.

Downloads

Published

10-10-2023

How to Cite

Hamidah, K. F., Rahmadi, M., Abdissalam, E., Septiani, I., Utomo, F. N., & Batubara, W. R. (2023). Medication complexity and COVID-19 pandemic impact on the cost burden in non-COVID elderly patients at the emergency department. Pharmacy Education, 23(4), p. 264–268. https://doi.org/10.46542/pe.2023.234.264268

Issue

Section

Special Edition