A Critical Review of Admission and Discharge Medications in an Elderly Australian Population

Abstract

Medications were examined on admission to and discharge from hospital in an elderly population. Polypharmacy was documented. Patients were discharged on more medications (4:7) than they were taking prior to admission (4.1). This was statistically significant in men (p < 0.001) but not women. Multiple medication changes were undertaken. Admission drug regimens perceived by patient, admitting hospital doctor and general practitioner were also compared. Of 64 patients who were able to name their medications, only 64% described the same list as admitting doctors and only 43% described the same list as general practitioners. Hospital doctor and general practitioner lists were the same in only 37% of cases. Communication between these 3 groups needs to be optimised.

Changes in drug therapy following hospital discharge for patients in a general practice: a German incident study

“…However, in Germany it is far from reality and difficult to put into practice. Besides improvement in communication between family and hospital doctors via transmission of more detailed information about drug changes to the discharge medication list (Clintborg et al 2007;Gonski et al 1993), perhaps more patient information, such as pharmaceutical counseling and better informing of patients concerning their pharmaceutical care plan, might be helpful to reduce posthospital drug prescribing (Al-Rashed et al 2002;Sorensen et al 2004). Furthermore, use of modern media like the world-wide web in primary care practices opens up new possibilities for better maintenance of adequate drug treatment after hospital discharge.…”

Polypharmacy and medication adherence

“…Given the current circumstances of poor information on medication use, 14 what are the prospects for physicians obtaining more accurate lists of medications for their patients? Resources permitting, two options are visiting home nurses and community pharmacists.…”

An Intervention on Discharge Polypharmacy

“…Gosney and Tallis 14 reported a 62% increase in medications from admission to discharge among older patients admitted to general medical and geriatric beds of a teaching hospital. Another report found an increase of only 15% among older patients admitted to the medical service, but it did not include medications prescribed prn (as needed) 15 . Two studies found no significant increase in the number of medications 16,17 .…”

“…However, all of these studies 14–17 found a number of inappropriate prescriptions. In contrast with these reports of increases or no change from admission to discharge, physicians were able to decrease medications at discharge by 17% 18 and 34% 19 among older patients hospitalized on geriatric units.…”