Skip to main content

Advertisement

SpringerLink
Log in

Continuity of long-term medication use after surgical hospital stay

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Objectives

To investigate changes in long-term medication during the transfer between surgical hospital and primary care. To examine differences in defined daily doses (DDDs) versus real prescribed daily doses (PDDs).

Methods

During a 15-month period, patients from three surgical wards in a university-based teaching hospital were asked about their medication at admission (T1), at discharge (T2), and 3 months after discharge (T3). Complete data were obtained for 299 patients (169 women, 130 men; mean age 69.5 years). Both DDD and PDD were calculated for each drug. Analysis of data was performed using a relational database.

Results

Patients took 3.6 drugs (±2.2) at T1, 5 (±2.4) at T2, and 3.8 (±3.1) at T3. After surgical intervention, a discontinuation of analgesic, anti-rheumatic, and thyroid medication was observed frequently (35% of discontinued drugs at T2). We found more drug alterations at T3 than at T2 (263 versus 87). Family doctors mostly changed medications prescribed for the cardiovascular system (22% of all cardiovascular agents were discontinued and/or started at T3). We could not determine those changes to be methodical. The total of PDDs and DDDs did not differ, but the mean PDDs of statins and beta-blocking agents were significantly below the DDDs (P<0.005).

Conclusion

The observed changes in medication after hospitalization can be only partially attributed to a successful surgical intervention and to the hospital stay. Those alterations seemed not to be initiated by the intention of saving costs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cummings RG (1998) Epidemiology of medication related falls and fractures in the elderly. Drugs Aging 12:43–53

    PubMed  Google Scholar 

  2. Vlahovic-Palcevski V, Bergman U (2004) Quality of prescribing for the elderly in Croatia-computerized pharmacy data can be used to screen for potentially inappropriate prescribing. Eur J Clin Pharmacol 60:217–220

    Article  PubMed  Google Scholar 

  3. Schwabe U, Pfaffrath D (2001) Arzneiverordnungsreport 2001. Springer, Berlin Heidelberg New York

    Google Scholar 

  4. Pittrow D, Kirch W, Bramlage P, Lehnert H, Hofler M, Unger T, Sharma AM, Wittchen HU (2004) Patterns of antihypertensive drug utilization in primary care. Eur J Clin Pharmacol 60:135–142

    Google Scholar 

  5. Pittrow D, Wittchen U, Kirch W (2003) Hypertension and diabetes care among primary care doctors in Germany. Result from an epidemiological cross-sectional study. In: Kirch W (ed) Public health in Europe. Springer, Berlin Heidelberg New York, pp 203–218

    Google Scholar 

  6. Beers MH, Dang J, Hasegawa J, Tamai IY (1989) Influence on hospitalization on drug therapy in the elderly. J Am Geriatr Soc 37:679–683

    CAS  PubMed  Google Scholar 

  7. Omori DM, Potyk RB, Kroenke K (1991) The adverse effects of hospitalization on drug regimes. Arch Intern Med 151:1562–1564

    Article  CAS  PubMed  Google Scholar 

  8. Himmel W, Kochen MM, Sorns U, Hummers-Pradier E (2004) Drug changes at the interface between primary and secondary care. Int J Clin Pharmacol Ther 42:103–109

    CAS  PubMed  Google Scholar 

  9. Gerety MB, Cornell JE, Plichta DT, Eimer M (1993) Adverse events related to drugs and drug withdrawal in nursing home residents J Am Geriatr Soc 41:1326–1332

    CAS  PubMed  Google Scholar 

  10. Greco P, Eisenber J (1995) Changing physicians’ practises. N Engl J Med 329:1271–1274

    Article  Google Scholar 

  11. Adl S, Weltermann BM, Kuching A, Martin C, Korbonits G, Hopp HW (2001) Difficulties in the transfer of drug therapy from inpatient to ambulatory treatment (Article in German). Gesundheitswesen 63:597–601

    Article  CAS  PubMed  Google Scholar 

  12. Sachverständigenrat für die Konzertierte Aktion im Gesundheitswesen. Bedarfsgerechtigkeit und Wirtschaftlichkeit. Bd. 1 Zielbildung, Prävention, Nutzerorientierung und Partizipation (expert panel for the concerted action in the healthcare system. Requirements and economic viability: targets, prevention and patient participation). Bonn, 2001

  13. WHO Collaborating Centre for Drug Statistics Methodology (2004) The ATC/DDD System. Oslo

  14. Lee D, Bergman U (2000) Studies of drug utilization. In: Strom BL (ed) Pharmacoepidemiology. Wiley, New York, pp 463–481

    Google Scholar 

  15. Wissenschaftliches Institut der AOK (WIdO) (2001) GKV Arzneimittel Schnellinformation Auswertung für die KV Sachsen. WIdO, Bonn

  16. Hach I, Rentsch A, Krappweis J, Kirch W (2004) Prescriptions of psychoactive drugs to elderly A comparison between nursing home residents with need of care and patients living at home with and without need of care (Article in German). Z Gerontol Geriatr 37:214–220

    Article  CAS  PubMed  Google Scholar 

  17. Himmel W, Tabache M Kochen MM (1996) What happens to long-term medication when general practice patients are referred to hospital? Eur J Clin Pharmacol 50:253–257

    Article  CAS  PubMed  Google Scholar 

  18. Bookwar K, Fishman E, Kyriacou CK, Monias A, Gavi S, Cortez T (2004) Adverse events due to discontinuation in drug use in dose changes in patients transferred between acute and long-term care facilities. Arch Intern Med 164:545–550

    Article  PubMed  Google Scholar 

  19. Himmel W, Kron M, Thies-Zajonc S, Kochen MM (1997) Changes in drug prescribing under the public health reform law–a survey of general practitioners’ attitudes in East and West Germany. Int J Clin Pharmacol Ther 35:164–169

    CAS  PubMed  Google Scholar 

  20. Walley T, Roberts D (2000) Average daily quantities–a tool for measuring prescribing volume in England. Pharmacoepidemiol Drug Safety 9:55–58

    Article  Google Scholar 

  21. McKenney JM (2004) Optimizing LDL-C lowering with statins. Am J Ther 11:54–59

    Article  PubMed  Google Scholar 

  22. Larsen J, Vaccheri A, Andersen M, Montanaro N, Bergman U (2000) Lack of adherence to lipid-lowering drug treatment A comparison of utilization patterns in defined populations in Funen, Denmark and Bologna, Italy. Br J Clin Pharmacol 49:463–471

    Article  CAS  PubMed  Google Scholar 

  23. Batalla A, Hevia S, Reguero JR, Cubero GI (2000) Underutilization of lipid-lowering therapy in coronary artery disease. Arch Intern Med 160:2683–2684

    Article  CAS  PubMed  Google Scholar 

  24. Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC, Cadoret C, Fish LS, Garber L, Kelleher M, Bates DW (2003) Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 289:1107–1116

    Article  PubMed  Google Scholar 

  25. Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, Farrar K, Park BK, Breckenridge AM (2004) Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 329:15–19

    Article  PubMed  Google Scholar 

  26. Melnyk PS, Shevchuk YM, Remillard AJ (2000) Impact of the dial access drug information service on patient outcome. Ann Pharmacother 34:585–592

    Google Scholar 

Download references

Acknowledgements

The authors wish to thank the many people who helped with this study, especially Dr. Jutta Krappweis for initiating the study, Anke Rentsch for her technical support, and the residents and nurses at the Elblandklinikum Meißen. The authors declare that the study complies with the current laws of Germany.

Author information

Authors and Affiliations

  1. Medical Faculty, Institute of Clinical Pharmacology, Technical University of Dresden, Fiedlerstr 27, 01307, Dresden, Germany

    I. Hach, U. Maywald, D. Meusel, J. U. König & W. Kirch

Authors
  1. I. Hach
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. U. Maywald
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Meusel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. U. König
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Kirch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. Hach.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hach, I., Maywald, U., Meusel, D. et al. Continuity of long-term medication use after surgical hospital stay. Eur J Clin Pharmacol 61, 433–438 (2005). https://doi.org/10.1007/s00228-005-0934-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-005-0934-5

Keywords

Search

Navigation