Unintended discontinuation of medication following hospitalisation: a retrospective cohort study

Abstract

ObjectivesWhether unintended discontinuation of common, evidence-based, long-term medication occurs after hospitalisation; what factors are associated with unintended discontinuation; and whether the presence of documentation of medication at hospital discharge is associated with continuity of medication in general practice.DesignRetrospective cohort study between 2012 and 2015.SettingElectronic records and hospital supplied discharge notifications in 44 Irish general practices.Participants20 488 patients aged 65 years or more prescribed long-term medication for chronic conditions.Primary and secondary outcomesDiscontinuity of four evidence-based medication drug classes: antithrombotic, lipid-lowering, thyroid replacement drugs and respiratory inhalers in hospitalised versus non-hospitalised patients; patient and health system factors associated with discontinuity; impact of the presence of medication in the hospital discharge summary on continuity of medication in a patient’s general practitioner (GP) prescribing record at 6 months follow-up.ResultsIn patients admitted to hospital, medication discontinuity ranged from 6%–11% in the 6 months posthospitalisation. Discontinuity of medication is significantly lower for hospitalised patients taking respiratory inhalers (adjusted OR (AOR) 0.63, 95% CI (0.49 to 0.80), p<0.001) and thyroid medications (AOR 0.62, 95% CI (0.40 to 0.96), p=0.03). There is no association between discontinuity of medication and hospitalisation for antithrombotics (AOR 0.95, 95% CI (0.81 to 1.11), p=0.49) or lipid lowering medications (AOR 0.92, 95% CI (0.78 to 1.08), p=0.29). Older patients and those who paid to see their GP were more likely to experience increased odds of discontinuity in all four medicine groups. Less than half (39% to 47.4%) of patients had medication listed on their hospital discharge summary. Presence of medication on hospital discharge summary is significantly associated with continuity of medication in the GP prescribing record for lipid lowering medications (AOR 1.64, 95% CI (1.15 to 2.36), p=0.01) and respiratory inhalers (AOR 2.97, 95% CI (1.68 to 5.25), p<0.01).ConclusionDiscontinuity of evidence-based long-term medication is common. Increasing age and private medical care are independently associated with a higher risk of medication discontinuity. Hospitalisation is not associated with discontinuity but less than half of hospitalised patients have medication recorded on their hospital discharge summary.

Assessment of an Electronic Patient Record System on Discharge Prescribing Errors in a Tertiary University Hospital

“…There is a signi cant body of evidence in the Irish context that the omission of medications from discharge prescriptions and discharge summaries has an impact on patient care, and is therefore a strong marker of iatrogenic risk [2,3,[5][6][7][8][10][11][12]. This study found that a multi-component educational intervention had a small effect on improving prescribing errors and communication at discharge.…”

Prescription Rates for Antiplatelet Therapy (APT) in Coronary Artery Disease (CAD) – What Benchmark are We Aiming at in Continuing Medical Education (CME)?

“…All the aforementioned variables also negatively influence long-term adherence, which has further been shown to decline due to poor health literacy, cognitive or psychic impairment, and medication cost issues (among others) [18][19][20][21]. Long-term adherence to APT has been reported to decline substantially over time [17,22,23,24,25,26,27,28], but more favourable results have also been reported [5,6,10,12,[18][19][20][21].…”

Persistence with oral bisphosphonates and denosumab among older adults in primary care in Ireland

“…The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement was used in the conduct and reporting of this retrospective cohort study. [24] Setting and data source Data were collected as part of a larger study from 44 general practices in the Republic of Ireland in the areas of Dublin (n=30), Galway (n=11) and Cork (n=3) using the patient management software Socrates (www.socrates.ie) between January 2011 and 2017 [25,26]. Data, anonymised at the time of extraction, included demographic, clinical, prescribing and hospitalisation records of patients who were 65 years and older at the date of data extraction (2017).…”