Kate H. Gamble, Senior Editor
Following discharge from a hospital, patients are at an increased risk of unintentional discontinuation of commonly prescribed chronic disease medications, according to a study
published in the Journal of the American Medical Association
, which found that the risk is even greater for patients who were admitted to an intensive care unit.
“Transitions in care are vulnerable periods for patients during hospitalization. Medical errors during this period can occur as a result of incomplete or inaccurate communication as responsibility shifts from one physician to another,” the authors wrote.
In the study, Chaim M. Bell, MD, PhD, of St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences, Toronto, and colleagues examined the rates of unintended discontinuation of common medications for chronic diseases after acute care hospitalization and ICU admission. They used administrative records from 1997 to 2009 of all hospitalizations and outpatient prescriptions in Ontario, Canada, which included 396,380 patients aged 66 and older with continuous use of at least 1 of 5 medication groups prescribed for long-term use: statins, antiplatelet/anticoagulant agents, levothyroxine (medication for thyroid problems), respiratory inhalers, and gastric acid-suppressing drugs. Rates of medication discontinuation were compared across 3 groups: patients admitted to the ICU, patients hospitalized without ICU admission, and nonhospitalized patients.
The researchers found that patients admitted to the hospital were more likely to experience potentially unintentional discontinuation of medications than controls across all medication groups examined. The highest rate of medication discontinuation occurred in the antiplatelet or anticoagulant agent group (19.4%). In this group, there were 552 patients (22.8%) with an ICU admission who discontinued these medications after hospital discharge. In contrast, of the patients not admitted to the hospital who were receiving antiplatelet or anticoagulant medications, only 11.8% experienced medication discontinuation at 90 days. The respiratory inhaler group had the lowest rate of medication discontinuation (4.5%).
Dr. Bell and colleagues also found that there was an increased risk of medication discontinuation in patients with an ICU admission compared with nonhospitalized patients in 4 of the 5 medication groups.
Long-term data echoed similar results, as a 1-year follow-up of patients who discontinued medications showed an elevated risk for the secondary composite outcome of death, emergency department visit, or emergent hospitalization in the statins group and in the antiplatelet/anticoagulant agents group.
“Better communication and a system-based method have been advocated as possible solutions to improve medication continuity and safety,” wrote the authors, noting that these strategies can range from customized integrated hospital computer systems to simple preprinted forms. “However, their success is contingent on including all relevant clinicians and the patients themselves. Formal programs such as medication reconciliation and standard discharge summaries can provide a means to improve interdisciplinary communication, including with primary care clinicians. Identification of high-risk patients and transfers in care may help improve program efficiency and focus valuable resources.”