Post-discharge adjustment of medication in geriatric patients : A prospective cohort study.
Änderung der Entlassungsmedikation bei geriatrischen Patienten : Eine prospektive Kohortenstudie.
General practitioner
Hospital discharge
Polypharmacy
Potentially inappropriate medication
Prescription
Journal
Zeitschrift fur Gerontologie und Geriatrie
ISSN: 1435-1269
Titre abrégé: Z Gerontol Geriatr
Pays: Germany
ID NLM: 9506215
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
received:
21
05
2019
accepted:
05
08
2019
pubmed:
24
8
2019
medline:
13
1
2021
entrez:
24
8
2019
Statut:
ppublish
Résumé
Little is known to what extent general practitioners (GP) change hospital discharge medications in older patients. This prospective cohort study aimed to analyze medication changes at the interface between hospital and community in terms of quality, quantity and type of drugs. A total of 121 out of 248 consecutively enrolled patients admitted to an acute geriatric hospital unit participated in the study. Medication regimens were recorded at admission and discharge and 4 weeks after hospital discharge the general practitioners in charge were contacted to provide the current medication charts. Changes in the extent of polypharmacy, in the type of drugs using anatomical therapeutic chemical classification (ATC) codes and potentially inappropriate medications (PIM) were analyzed. Medication charts could be obtained for 98 participants in primary care. Only 21% of these patients remained on the original discharge medication. Overall, the average number of medications rose from hospital admission (6.58 SD ± 3.45) to discharge (6.96 SD ± 3.49) and again post-discharge in general practice (7.22 SD ± 3.68). The rates of patients on excessive polypharmacy (≥10 drugs) and on PIM were only temporarily reduced during hospital stay. The GPs stopped anti-infective drugs (ATC-J) and prescribed more antirheumatic drugs (ATC-M). Although no significant net changes occurred in other ATC groups, a substantial number of drugs were interchanged regarding the subgroups. The study found that GPs extensively adjusted geriatric discharge medications. Whereas some changes may be necessary due to alterations in patients' state of health, a thorough communication between hospital doctors and GPs may level off different prescribing cultures and contribute to consistency in medication across sectors.
Sections du résumé
BACKGROUND
BACKGROUND
Little is known to what extent general practitioners (GP) change hospital discharge medications in older patients.
OBJECTIVE
OBJECTIVE
This prospective cohort study aimed to analyze medication changes at the interface between hospital and community in terms of quality, quantity and type of drugs.
METHODS
METHODS
A total of 121 out of 248 consecutively enrolled patients admitted to an acute geriatric hospital unit participated in the study. Medication regimens were recorded at admission and discharge and 4 weeks after hospital discharge the general practitioners in charge were contacted to provide the current medication charts. Changes in the extent of polypharmacy, in the type of drugs using anatomical therapeutic chemical classification (ATC) codes and potentially inappropriate medications (PIM) were analyzed.
RESULTS
RESULTS
Medication charts could be obtained for 98 participants in primary care. Only 21% of these patients remained on the original discharge medication. Overall, the average number of medications rose from hospital admission (6.58 SD ± 3.45) to discharge (6.96 SD ± 3.49) and again post-discharge in general practice (7.22 SD ± 3.68). The rates of patients on excessive polypharmacy (≥10 drugs) and on PIM were only temporarily reduced during hospital stay. The GPs stopped anti-infective drugs (ATC-J) and prescribed more antirheumatic drugs (ATC-M). Although no significant net changes occurred in other ATC groups, a substantial number of drugs were interchanged regarding the subgroups.
CONCLUSION
CONCLUSIONS
The study found that GPs extensively adjusted geriatric discharge medications. Whereas some changes may be necessary due to alterations in patients' state of health, a thorough communication between hospital doctors and GPs may level off different prescribing cultures and contribute to consistency in medication across sectors.
Identifiants
pubmed: 31440831
doi: 10.1007/s00391-019-01601-8
pii: 10.1007/s00391-019-01601-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM