Association between unmet medication needs after hospital discharge and readmission or death among acute respiratory failure survivors: the addressing post-intensive care syndrome (APICS-01) multicenter prospective cohort study
Authors: Brown Samuel M. , Dinglas Victor D. , Akhlaghi Narjes , Bose Somnath , Banner-Goodspeed Valerie , Beesley Sarah , Groat Danielle , Greene Tom , Hopkins Ramona O. , Mir-Kasimov Mustafa , Sevin Carla M. , Turnbull Alison E. , Jackson James C. , Needham Dale M. ,   for the APICS-01 Study Team, Caraker Elise , Cherukuri Sai Phani Sree , Kadiri Naga Preethi , Kalva Tejaswi , Koneru Mounica , Kota Pooja , Lee Emma Maelian , Mahmoud Mazin Ali , Malik Albahi , Nikooie Roozbeh , Roberts Darin , Singu Sriharsha , Vaziri Parvaneh , Brown Katie , Daw Austin , Merrill Mardee , Smith Rilee , Hirshberg Ellie , Butler Jorie , Hoenig Benjamin , Karamourtopoulos Maria , Hays Margaret , Abel Rebecca , High Craig , Beck Emily , Armbruster Brent , Applegate Darrin , Fergus Melissa , Kumar Naresh , Roth Megan , Mogan Susan , Abel Rebecca , De Souza Licht Andrea , Londono Isabel , Larson Julia , Capers Krystal , Karamourtopoulos Maria , Hoenig Benjamin , Toksoz-Exley Andrew , Crane Julia 
Published: January 2022

Abstract
Introduction
Survivors of acute respiratory failure (ARF) commonly experience long-lasting physical, cognitive, and/or mental health impairments. Unmet medication needs occurring immediately after hospital discharge may have an important effect on subsequent recovery.

Methods and analysis
In this multicenter prospective cohort study, we enrolled ARF survivors who were discharged directly home from their acute care hospitalization. The primary exposure was unmet medication needs. The primary outcome was hospital readmission or death within 3 months after discharge. We performed a propensity score analysis, using inverse probability weighting for the primary exposure, to evaluate the exposure–outcome association, with an a priori sample size of 200 ARF survivors.

Results
We enrolled 200 ARF survivors, of whom 107 (53%) were female and 77 (39%) were people of color. Median (IQR) age was 55 (43–66) years, APACHE II score 20 (15–26) points, and hospital length of stay 14 (9–21) days. Of the 200 participants, 195 (98%) were in the analytic cohort. One hundred fourteen (57%) patients had at least one unmet medication need; the proportion of medication needs that were unmet was 6% (0–15%). Fifty-six (29%) patients were readmitted or died by 3 months; 10 (5%) died within 3 months. Unmet needs were not associated (risk ratio 1.25; 95% CI 0.75–2.1) with hospital readmission or death, although a higher proportion of unmet needs may have been associated with increased hospital readmission (risk ratio 1.7; 95% CI 0.96–3.1) and decreased mortality (risk ratio 0.13; 95% CI 0.02–0.99).

Discussion
Unmet medication needs are common among survivors of acute respiratory failure shortly after discharge home. The association of unmet medication needs with 3-month readmission and mortality is complex and requires additional investigation to inform clinical trials of interventions to reduce unmet medication needs.
Study registration number: NCT03738774. The study was prospectively registered before enrollment of the first patient.