Restarting Medications After Deprescribing in Adults Discharged From Hospital to Skilled Nursing

Among older adults discharged to skilled nursing facilities (SNFs) after hospital-initiated deprescribing, what is the frequency and timing of medication restarts, what factors are associated with restarts, and is there an association between restarts and health care utilization?In this cohort study analyzing data from 2 randomized trials with a total of 598 participants, 15.9% of deprescribed medications were restarted. Higher health literacy and longer intervention exposure were associated with fewer restarts, whereas more prescribers, higher number of baseline medications, and fewer pharmacies were associated with medication restarts; restart during the SNF stay was associated with greater 90-day hospital readmissions.These findings suggest deprescribing durability for hospitalized older patients declines after the SNF-to-home transition; targeting high-risk patients and improving prescriber-pharmacy coordination during care transitions may reduce medication restarts and hospital readmissions.

Corresponding Author: Thomas J. Reese, PharmD, PhD, Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 W End Ave, Ste 1475, Nashville, TN 37203 (sandra.simmons@vumc.org).

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