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Post-discharge adjustment of medication in geriatric patients

A prospective cohort study

Änderung der Entlassungsmedikation bei geriatrischen Patienten

Eine prospektive Kohortenstudie

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Abstract

Background

Little is known to what extent general practitioners (GP) change hospital discharge medications in older patients.

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

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

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

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.

Zusammenfassung

Hintergrund

Es ist nur wenig über Art und Umfang von Medikationsänderungen bei geriatrischen Patienten an der Schnittstelle von Krankenhausentlassung und hausärztlicher Versorgung bekannt.

Ziel

Ziel dieser prospektiven Studie ist es, die Änderungen der Medikation in Hinblick auf die Qualität und Quantität genauer zu analysieren.

Methoden

Von 248 Patienten, welche in eine geriatrische Klinik eingewiesen wurden, nahmen 121 Patienten teil. Die Medikationspläne wurden bei Aufnahme, bei Entlassung und 4 Wochen nach der Entlassung (über Kontakt zum jeweiligen Hausarzt) erfasst und auf den Anteil an Polypharmazie, potenziell inadäquater Medikation (PIM) sowie Art der Medikation (ATC-Code) hin analysiert.

Ergebnisse

Für 98 Patienten lagen die Medikationspläne vollständig vor. Nur bei 21 % der Patienten führten die Hausärzte die Medikation unverändert fort. Insgesamt zeigte sich eine Zunahme der Medikamentenanzahl zwischen Aufnahme (6,58 Standardabweichung [SD] ± 3,45), Entlassung (6,96 SD ± 3,49) und 4 Wochen nach der Entlassung (7,22 SD ± 3,68). Der Anteil an Patienten mit schwerer Polypharmazie (≥10 Medikamente) und PIM konnte durch den Krankenhausaufenthalt nur temporär reduziert werden. Die Hausärzte beendeten Antiinfektiva (ATC-J) und setzten signifikant mehr Antirheumatika (ATC-M) an. In den weiteren Subgruppen kam es zu wesentlichen, aber nicht signifikanten Änderungen.

Schlussfolgerung

Hausärzte ändern die Entlassungsmedikation geriatrischer Patienten in großem Umfang. Auch wenn manche Änderungen möglicherweise einem veränderten Gesundheitszustand der Patienten geschuldet sind, könnte dennoch eine bessere Kommunikation an der Schnittstelle dazu beitragen, das jeweilige Verschreibungsverhalten abzugleichen und eine Kontinuität der Medikation zu gewährleisten.

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Acknowledgements

The authors gratefully acknowledge the contributions of all participating geriatric patients (and their next of kin and legal representatives) and GPs.

Funding

This study was not supported by any kind of funding.

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Authors

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Correspondence to Olaf Krause.

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Conflict of interest

O. Krause, S. Glaubitz, K. Hager, T. Schleef, B. Wiese and U. Junius-Walker declare that they have no competing interests.

All procedures performed in this study were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval was given by the ethics committees at the Hannover Medical School (Nr. 2350-2014).

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Krause, O., Glaubitz, S., Hager, K. et al. Post-discharge adjustment of medication in geriatric patients. Z Gerontol Geriat 53, 663–670 (2020). https://doi.org/10.1007/s00391-019-01601-8

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  • DOI: https://doi.org/10.1007/s00391-019-01601-8

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