Epidemiology and Long-Term Effect of Cardiometabolic Medication Substitution during Post-acute Care

PROJECT SUMMARY/ABSTRACT Nearly 70% of older adults experience medication discrepancy–inconsistencies in medication regimens when they transition from acute hospital to skilled nursing facilities (SNF). Medication discrepancy in this period often results from inadequate reconciliation processes and formulary or financial restrictions in hospitals or SNFs.

Medication discrepancy can take the various forms, including omission, addition, duplication, and substitution. Among these types, substitution accounts for up to 20% and frequently involves cardiovascular medications. Clinical observations suggest that newer, high-cost cardiometabolic medications (e.g., angiotensin receptor

neprilysin inhibitor, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide 1 receptor agonists) are often substituted with less expensive and less efficacious alternatives in SNFs. Such substitutions may impact chronic disease outcomes if the modified regimen is continued after SNF stay. Despite the common occurrence

of medication substitution during SNF stays and its potential clinical significance, systematic investigation has been hindered by the lack of a comprehensive database containing medication administration records from a large number of SNFs. The objective of this study is to determine the epidemiology and clinical consequences

of cardiometabolic medication substitution in SNF. The investigators’ hypothesis is that persistent medication substitution beyond SNF stay is associated with worse outcomes compared with no substitution or resolved substitution during SNF stay. To test this hypothesis, they will use the Long-Term Care Data Cooperative platform,

which provides electronic health records data from nationwide SNFs linked with Medicare data. The specific aims are: 1) to determine the frequency and factors associated with cardiometabolic medication substitution during post-acute SNF stay among older adults after elective orthopedic surgery; and 2) to determine long-term

chronic disease outcomes associated with cardiometabolic medication substitution during post-acute SNF stay. The project is innovative because it is the first national-scale study of medication substitution during the post- acute SNF stay. The impact of this research is significant because the evidence generated from this research

can enable optimal medication management of cardiometabolic conditions in the transitional period. Moreover, the GEMSSTAR award will provide mentorship, training, and experience for the Principal Investigator to emerge as a leader in optimizing medication use for older adults.