How are drug regimen changes during hospitalisation handled after discharge: a cohort study

Abstract

ObjectivesTo investigate drug regimen changes during hospitalisation and explore how these changes are handled after patients are transferred back into the care of their general practitioners (GPs).DesignCohort study.SettingPatients in this multicentre study had undergone at least one change in their drug regimens at discharge from the general medicine departments at six hospitals in Norway. These changes were altered doses, discontinuation of drugs or start of new drugs. Clinical pharmacists visited the patients’ GPs 4–5 months after patient discharge and recorded any additional drug regimen changes.ResultsIn total, 105 patients (mean age 76.1 years, 54.3% women) completed the study. On average, they used 5.6 drugs at admission (range 0–16) and 7.6 drugs at discharge (range 1–17). On average, 4.4 drug changes per patient (SD 2.7, range 1–16) were made at the hospital, and 3.4 drug changes per patient (SD 2.9, range 0–14) within 4–5 months of discharge. Of the 465 drug changes made in hospital, 153 were changed again after discharge (mean 1.5 per patient, SD 1.8, range 0–13). The drug regimens of 90 of these 105 patients were changed after discharge. The OR for extensive drug changes after discharge (≥ 4 changes) increased significantly with the number of drugs used at discharge from hospital (OR=1.29, 95% CI 1.04 to 1.59). Only 68 of 105 discharge notes contained complete drug lists, and only 24 of the discharge notes were received by the GPs within 7 days.ConclusionsIn addition to the extensive changes in drug regimens during hospitalisation, almost equally extensive changes were made in the initial months after discharge. Surveillance of drug regimens is particularly necessary in the period immediately after hospital discharge.

Reducing Cardiovascular Medication Complexity in a German University Hospital: Effects of a Structured Pharmaceutical Management Intervention on Adherence

“…30,31 Similar results were obtained by Viktil et al (2012), and a marked influence of hospitalization on changes in drug therapy in ambulatory care was shown. 32,33 investigated the association between changes of medication regimens and adherence following hospital discharge. Nonadherence to at least 1 drug was associated with more extensive medication regimen changes and was more common in patients discharged with prescriptions for 7 or more drugs per day.…”

“…29 Concerning changes in therapy, Himmel et al (1996; found that about 50% of the medications used for chronic treatment were changed during hospitalization. 30,31 Similar results were obtained by Viktil et al (2012), and a marked influence of hospitalization on changes in drug therapy in ambulatory care was shown. 32,33 investigated the association between changes of medication regimens and adherence following hospital discharge.…”

Do Electronic Discharge Summaries Contain More Complete Medication Information? A Retrospective Analysis of Paper versus Electronic Discharge Summaries

“…This is similar to what has previously been reported (Himmel et al 2004;Grimmsmann, Schwabe & Himmel 2007;Viktil et al 2012;Harris et al 2013). When the electronic discharge summary system was designed, a free-text box was included in the electronic discharge summary to facilitate the inclusion of explanations for medication changes, to improve communication to GPs and to ensure continued appropriate medication management post-discharge (Ng et al 2013).…”

How does hospitalization affect continuity of drug therapy: an exploratory study

“…Previous research has shown that extensive changes in patients’ drug regimens were made during their hospital stays, and almost equally extensive changes were undertaken after the patients were transferred back into the care of their general practitioners 1–3. In a study based on a prescription database, it was found that hospitalization markedly influenced medical therapy in ambulatory care 4.…”