Rate of early hospital readmission amongst cirrhotic patients is high in Australia: experience from a single liver transplant centre.

BACKGROUND AND AIMS: The 30-day hospital readmission rate in cirrhotic patients has been demonstrated to be up to 40% in international studies, but is not well studied in Australia. The aim of the current study was to report on the rate and cause of 30-day hospital readmission from a single liver transplant referral centre, including a cost analysis of readmissions. METHODS: This was a retrospective study of consecutive cirrhotic patients admitted to a liver transplant centre in Victoria, Australia, between 1 January 2019 and 31 December 2019. Cases were identified through International Classification of Diseases, Tenth Revision, 10 coding for cirrhosis and its complications. Baseline demographic data, liver-related complications and unrelated extra-hepatic comorbidities, laboratory values and prognostic scores were collected from the electronic medical record. RESULTS: One hundred seventy-nine (63% men; median age at index admission, 59 years) patients who were admitted 427 times during the study period were included in the final analysis. The 30-day hospital readmission rate was 46%, with the majority of readmissions attributable to fluid overload (29%), miscellaneous reasons (27%) and infection (20%). One fifth of readmissions were considered preventable. History of variceal haemorrhage was found to be an independent predictor of 30-day hospital readmission. The annual cost of readmission is over AU$2.7 million and the median cost of hospital readmission was about AU$9000. CONCLUSIONS: The 30-day hospital readmission rate of 46% is higher than previously reported and almost half of cases were caused by either fluid overload or infection.

Validation and psychometric properties of the 8-item Morisky Medication Adherence Scale (MMAS-8) in Type 2 diabetes patients in sub-Saharan Africa.

OBJECTIVES: Research in the field of adherence to medications has not been explored in sub-Saharan Africa. The goal of this manuscript is to (1) validate the use of an adherence tool: a translated 8-item Morisky Medication Adherence Scale (MMAS-8) for Type 2 diabetes and (2) assess association between levels of adherence and psychometric properties. METHODS: 154 Type 2 diabetic patients being chronically treated were surveyed from Togolese Diabetes Association using a demographic survey, 4-item Morisky Medication Adherence Scale (MMAS-4) and MMAS-8 from January to March 2012. RESULTS: Internal reliability for the 8-item scale showed the Cronbach alpha being 0.47. The MMAS-8 and MMAS-4 showed a Pearson's correlation of 0.6851. For known groups validity, the chi-square (χ(2)) tests of proportions showed a significant relationship between blood glucose control and MMAS-8 (χ(2)=12.17; p=0.002). The sensitivity, specificity, positive predictive value and negative predictive value were 75%, 48.39%, 56.76%, and 68.18% respectively. CONCLUSIONS: Psychometric analyses showed that the MMAS-8 was a suitable way of measuring medication adherence in the study population given its low cost, ease of use, and the low income status of the country.