TY - JOUR
T1 - Unintended discontinuation of medication following hospitalisation: a retrospective cohort study
AU - Redmond, Patrick
AU - McDowell, Ronald
AU - Grimes, Tamasine C
AU - Boland, Fiona
AU - Ronan, McDonnell
AU - Hughes, Carmel
AU - Fahey, Tom
PY - 2019/6/4
Y1 - 2019/6/4
N2 - Objectives Whether 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.
Design Retrospective cohort study between 2012 and
2015.
Setting Electronic records and hospital supplied
discharge notifications in 44 Irish general practices.
Participants 20 488 patients aged 65 years or more
prescribed long-term medication for chronic conditions.
Primary and secondary outcomes Discontinuity 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
6months follow-up.
Results In patients admitted to hospital, medication
discontinuity ranged from 6%–11% in the 6months
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).
Conclusion Discontinuity 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.
AB - Objectives Whether 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.
Design Retrospective cohort study between 2012 and
2015.
Setting Electronic records and hospital supplied
discharge notifications in 44 Irish general practices.
Participants 20 488 patients aged 65 years or more
prescribed long-term medication for chronic conditions.
Primary and secondary outcomes Discontinuity 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
6months follow-up.
Results In patients admitted to hospital, medication
discontinuity ranged from 6%–11% in the 6months
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).
Conclusion Discontinuity 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.
U2 - 10.1136/bmjopen-2018-024747
DO - 10.1136/bmjopen-2018-024747
M3 - Article
SN - 2044-6055
VL - 9
JO - BMJ Open
JF - BMJ Open
M1 - e024747
ER -