The influence of hospitalisation on drug prescription in primary care – a large-scale follow-up study

Grimmsmann, Thomas; Schwabe, Ulrike; Himmel, Wolfgang

doi:10.1007/s00228-007-0325-1

Cited by 71 publications

(48 citation statements)

References 22 publications

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“…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).…”

Section: Discussionmentioning

confidence: 91%

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

Lehnbom

Raban

Walter

et al. 2014

HIM J

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Complete, accurate and timely hospital discharge summaries are important for continuity of care. The aim of this study was to evaluate the effectiveness of an electronic discharge summary system in improving the medication information provided compared to the information in paper discharge summaries. We conducted a retrospective audit of 199 paper and 200 electronic discharge summaries from a 350-bed teaching hospital in Sydney, Australia. The completeness of medication information, and whether medication changes during the admission were explained, were assessed. Further, the likelihood of any incomplete information having an impact on continuity of care was assessed. There were 1352 and 1771 medication orders assessed in paper and electronic discharge summaries, respectively. Of these, 90.9% and 93.4% were complete in paper and electronic discharge summaries, respectively. The dose (OR 25.24, 95%CI: 3.41-186.9) and route (OR 8.65, 95%CI: 3.46-21.59) fields of medication orders, were more likely to be complete in electronic as compared with paper discharge summaries. There was no difference for drug frequency (OR 1.09, 95%CI: 0.77-1.55). There was no significant improvement in the proportion of incomplete medication orders rated as unclear and likely to impede continuity of care in paper compared with electronic discharge summaries (7.3% vs. 6.5%). Of changes to medication regimen, only medication additions were more likely to be explained in the electronic (n=253, 37.2%) compared to paper (n=104, 14.3%) discharge summaries (OR 3.14; 95%CI: 2.20-4.18). In summary, electronic discharge summaries offer some improvements over paper discharge summaries in terms of the quality of medication information documented. However, explanations of changes to medication regimens remained low, despite this being crucial information. Future efforts should focus on including the rationale for changes to medication regimens in discharge summaries.

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Section: Discussionmentioning

confidence: 91%

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

Lehnbom

Raban

Walter

et al. 2014

HIM J

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“…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. When medication regimens are constantly modified and updated associated with a patient’s hospitalization, these modifications might increase the risk for nonadherence, polypharmacy, cost, and poor outcomes among elderly patients 5–7…”

Section: Introductionmentioning

confidence: 99%

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

Blozik

Signorell

Reich

2016

TCRM

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IntroductionTransitions between different levels of health care, such as hospital admission and discharge, pose a significant threat to the quality and continuity of medication therapy. This study aims to explore the role of hospitalization on medication changes as patients are transferred from and back to ambulatory care.MethodsSecondary analysis of claims data from Swiss residents with basic health insurance at the Helsana Group was performed. We evaluated medication invoices of patients who were hospitalized in a Swiss private hospital group in the year 2013. Medication changes were defined as discontinuation, new prescription, or change in the Anatomical Therapeutic Chemical (ATC) Classification System level 4, which is equivalent to a change in the chemical/therapeutic/pharmacological subgroup. Multiple Poisson regression analysis was applied to evaluate whether medication change was predicted by socioeconomic or clinical patient characteristics or by a system factor (physician dispensing of medication allowed in canton of residence).ResultsWe investigated a total of 10,123 hospitalized patients, among whom a mean number of 3.85 (median 3.00) changes were identified. Change most frequently affected antihypertensives, analgesics, and antirheumatics. If patients were enrolled in a managed care plan, they were less likely to undergo changes. If a patient resided in a canton, in which physicians were allowed to dispense medication directly, the patient was more likely to experience change.ConclusionThere is considerable change in medication when patients shift between ambulatory and inpatient health care levels. This interruption of medication continuity is in part desirable as it responds to clinical needs. However, we hypothesize that there is also a significant proportion of change due to unwarranted factors such as financial incentives for change of products.

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“…[1][2][3][4][5][6][7] However, in a study based on a prescription database, it was found that hospitalisation exerted a marked influence on changes in drug therapy in ambulatory care. 7 In a study of patients from one single ARTICLE SUMMARY Article focus ▪ Investigation of patients' drug regimen changes instituted during hospitalisation. ▪ Handling of these drug changes after transfer of the patients back into the care of their general practitioners (GPs).…”

Section: Introductionmentioning

confidence: 99%

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

Viktil¹,

Blix

Eek

et al. 2012

BMJ Open

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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.

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The influence of hospitalisation on drug prescription in primary care – a large-scale follow-up study

Abstract: Hospitalisation exerts a marked influence on drug therapy in ambulatory care, with a significant increase in the prescription of novel, on-patent drugs instead of less expensive alternatives.

Cited by 71 publications

References 22 publications

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

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

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

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

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