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22.08.2019 | Original Contributions

Post-discharge adjustment of medication in geriatric patients

A prospective cohort study

verfasst von: Dr. Olaf Krause, Stefanie Glaubitz, Klaus Hager, Tanja Schleef, Birgitt Wiese, Ulrike Junius-Walker

Erschienen in: Zeitschrift für Gerontologie und Geriatrie

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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.
Literatur
1.
Zurück zum Zitat American Geriatrics Society Beers Criteria Update Expert Panel (2012) American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60:616–631 CrossRef American Geriatrics Society Beers Criteria Update Expert Panel (2012) American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60:616–631 CrossRef
2.
Zurück zum Zitat Ammenwerth E, Schnell-Inderst P, Machan C et al (2008) The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. J Am Med Inform Assoc 15:585–600 CrossRef Ammenwerth E, Schnell-Inderst P, Machan C et al (2008) The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. J Am Med Inform Assoc 15:585–600 CrossRef
3.
Zurück zum Zitat Bolland MJ, Grey A, Avenell A (2018) Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis. Lancet Diabetes Endocrinol 6:847–858 CrossRef Bolland MJ, Grey A, Avenell A (2018) Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis. Lancet Diabetes Endocrinol 6:847–858 CrossRef
4.
Zurück zum Zitat Clyne B, Cooper JA, Hughes CM et al (2016) ‘Potentially inappropriate or specifically appropriate?’ Qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people. BMC Fam Pract 17:109 CrossRef Clyne B, Cooper JA, Hughes CM et al (2016) ‘Potentially inappropriate or specifically appropriate?’ Qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people. BMC Fam Pract 17:109 CrossRef
5.
Zurück zum Zitat Freyer J, Greissing C, Buchal P et al (2016) Discharge medication—what do patients know about their medication on discharge? Dtsch Med Wochenschr 141:e150–e156 CrossRef Freyer J, Greissing C, Buchal P et al (2016) Discharge medication—what do patients know about their medication on discharge? Dtsch Med Wochenschr 141:e150–e156 CrossRef
6.
Zurück zum Zitat Frisse S, Röhrig G, Franklin J et al (2016) Prescription errors in geriatric patients can be avoided by means of a computerized physician order entry (CPOE). Z Gerontol Geriatr 49:227–231 CrossRef Frisse S, Röhrig G, Franklin J et al (2016) Prescription errors in geriatric patients can be avoided by means of a computerized physician order entry (CPOE). Z Gerontol Geriatr 49:227–231 CrossRef
7.
Zurück zum Zitat Garcia-Caballos M, Ramos-Diaz F, Jimenez-Moleon JJ et al (2010) Drug-related problems in older people after hospital discharge and interventions to reduce them. Age Ageing 39:430–438 CrossRef Garcia-Caballos M, Ramos-Diaz F, Jimenez-Moleon JJ et al (2010) Drug-related problems in older people after hospital discharge and interventions to reduce them. Age Ageing 39:430–438 CrossRef
8.
Zurück zum Zitat Goldsmith H, Curtis K, McCloughen A (2017) Effective pain management in recently discharged adult trauma patients: Identifying patient and system barriers, a prospective exploratory study. J Clin Nurs 26:4548–4557 CrossRef Goldsmith H, Curtis K, McCloughen A (2017) Effective pain management in recently discharged adult trauma patients: Identifying patient and system barriers, a prospective exploratory study. J Clin Nurs 26:4548–4557 CrossRef
9.
Zurück zum Zitat Gracie R, Randall E, Alexander H (2014) A retrospective survey of elderly patients’ discharge summaries: are inpatient medication changes communicated to GPs? Age Ageing 43:ii2–ii3 CrossRef Gracie R, Randall E, Alexander H (2014) A retrospective survey of elderly patients’ discharge summaries: are inpatient medication changes communicated to GPs? Age Ageing 43:ii2–ii3 CrossRef
10.
Zurück zum Zitat Greissing C, Buchal P, Kabitz HJ et al (2016) Medication and treatment adherence following hospital discharge. Dtsch Arztebl Int 113:749–756 PubMedPubMedCentral Greissing C, Buchal P, Kabitz HJ et al (2016) Medication and treatment adherence following hospital discharge. Dtsch Arztebl Int 113:749–756 PubMedPubMedCentral
11.
Zurück zum Zitat Grischott T, Zechmann S, Rachamin Y et al (2018) Improving inappropriate medication and information transfer at hospital discharge: study protocol for a cluster RCT. Implement Sci 13:155 CrossRef Grischott T, Zechmann S, Rachamin Y et al (2018) Improving inappropriate medication and information transfer at hospital discharge: study protocol for a cluster RCT. Implement Sci 13:155 CrossRef
12.
Zurück zum Zitat Haastrup PF, Rasmussen S, Hansen JM et al (2016) General practice variation when initiating long-term prescribing of proton pump inhibitors: a nationwide cohort study. BMC Fam Pract 17:57 CrossRef Haastrup PF, Rasmussen S, Hansen JM et al (2016) General practice variation when initiating long-term prescribing of proton pump inhibitors: a nationwide cohort study. BMC Fam Pract 17:57 CrossRef
13.
Zurück zum Zitat Holt S, Schmiedl S, Thürmann PA (2010) Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int 107:543–551 PubMedPubMedCentral Holt S, Schmiedl S, Thürmann PA (2010) Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int 107:543–551 PubMedPubMedCentral
14.
Zurück zum Zitat Hopcroft P, Peel NM, Poudel A et al (2014) Prescribing for older people discharged from the acute sector to residential aged-care facilities. Intern Med J 44:1034–1037 CrossRef Hopcroft P, Peel NM, Poudel A et al (2014) Prescribing for older people discharged from the acute sector to residential aged-care facilities. Intern Med J 44:1034–1037 CrossRef
15.
Zurück zum Zitat Kanaan AO, Donovan JL, Duchin NP et al (2013) Adverse drug events after hospital discharge in older adults: types, severity, and involvement of Beers Criteria Medications. J Am Geriatr Soc 61:1894–1899 CrossRef Kanaan AO, Donovan JL, Duchin NP et al (2013) Adverse drug events after hospital discharge in older adults: types, severity, and involvement of Beers Criteria Medications. J Am Geriatr Soc 61:1894–1899 CrossRef
16.
Zurück zum Zitat Kuhn-Thiel AM, Weiss C, Wehling M et al (2014) Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging 31:131–140 CrossRef Kuhn-Thiel AM, Weiss C, Wehling M et al (2014) Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging 31:131–140 CrossRef
17.
Zurück zum Zitat Larsen MD, Rosholm JU, Hallas J (2014) The influence of comprehensive geriatric assessment on drug therapy in elderly patients. Eur J Clin Pharmacol 70:233–239 CrossRef Larsen MD, Rosholm JU, Hallas J (2014) The influence of comprehensive geriatric assessment on drug therapy in elderly patients. Eur J Clin Pharmacol 70:233–239 CrossRef
18.
Zurück zum Zitat Mansur N, Weiss A, Hoffman A et al (2008) Continuity and adherence to long-term drug treatment by geriatric patients after hospital discharge: a prospective cohort study. Drugs Aging 25:861–870 CrossRef Mansur N, Weiss A, Hoffman A et al (2008) Continuity and adherence to long-term drug treatment by geriatric patients after hospital discharge: a prospective cohort study. Drugs Aging 25:861–870 CrossRef
20.
Zurück zum Zitat O’Mahony D, O’Sullivan D, Byrne S et al (2015) STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 44:213–218 CrossRef O’Mahony D, O’Sullivan D, Byrne S et al (2015) STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 44:213–218 CrossRef
21.
Zurück zum Zitat Parsons M, Parsons J, Rouse P et al (2018) Supported discharge teams for older people in hospital acute care: a randomised controlled trial. Age Ageing 47:288–294 CrossRef Parsons M, Parsons J, Rouse P et al (2018) Supported discharge teams for older people in hospital acute care: a randomised controlled trial. Age Ageing 47:288–294 CrossRef
22.
Zurück zum Zitat Pederson JL, Majumdar SR, Forhan M et al (2016) Current depressive symptoms but not history of depression predict hospital readmission or death after discharge from medical wards: a multisite prospective cohort study. Gen Hosp Psychiatry 39:80–85 CrossRef Pederson JL, Majumdar SR, Forhan M et al (2016) Current depressive symptoms but not history of depression predict hospital readmission or death after discharge from medical wards: a multisite prospective cohort study. Gen Hosp Psychiatry 39:80–85 CrossRef
23.
Zurück zum Zitat Preyde M, Brassard K (2011) Evidence-based risk factors for adverse health outcomes in older patients after discharge home and assessment tools: a systematic review. J Evid Based Soc Work 8:445–468 CrossRef Preyde M, Brassard K (2011) Evidence-based risk factors for adverse health outcomes in older patients after discharge home and assessment tools: a systematic review. J Evid Based Soc Work 8:445–468 CrossRef
24.
Zurück zum Zitat Scales DC, Fischer HD, Li P et al (2016) Unintentional continuation of medications intended for acute illness after hospital discharge: A population-based cohort study. J Gen Intern Med 31:196–202 CrossRef Scales DC, Fischer HD, Li P et al (2016) Unintentional continuation of medications intended for acute illness after hospital discharge: A population-based cohort study. J Gen Intern Med 31:196–202 CrossRef
25.
Zurück zum Zitat Sorensen L, Stokes JA, Purdie DM et al (2005) Medication management at home: medication-related risk factors associated with poor health outcomes. Age Ageing 34:626–632 CrossRef Sorensen L, Stokes JA, Purdie DM et al (2005) Medication management at home: medication-related risk factors associated with poor health outcomes. Age Ageing 34:626–632 CrossRef
26.
Zurück zum Zitat Strehlau AG, Larsen MD, Sondergaard J et al (2018) General practitioners’ continuation and acceptance of medication changes at sectorial transitions of geriatric patients—a qualitative interview study. BMC Fam Pract 19:168 CrossRef Strehlau AG, Larsen MD, Sondergaard J et al (2018) General practitioners’ continuation and acceptance of medication changes at sectorial transitions of geriatric patients—a qualitative interview study. BMC Fam Pract 19:168 CrossRef
27.
Zurück zum Zitat Van Walraven C, Seth R, Austin PC et al (2002) Effect of discharge summary availability during post-discharge visits on hospital readmission. J Gen Intern Med 17:186–192 CrossRef Van Walraven C, Seth R, Austin PC et al (2002) Effect of discharge summary availability during post-discharge visits on hospital readmission. J Gen Intern Med 17:186–192 CrossRef
28.
Zurück zum Zitat Viktil KK, Blix HS, Eek AK et al (2012) How are drug regimen changes during hospitalisation handled after discharge: a cohort study. BMJ Open 2:e1461 CrossRef Viktil KK, Blix HS, Eek AK et al (2012) How are drug regimen changes during hospitalisation handled after discharge: a cohort study. BMJ Open 2:e1461 CrossRef
29.
Zurück zum Zitat Wehling M, Burkhardt H, Kuhn-Thiel A et al (2016) VALFORTA: a randomised trial to validate the FORTA (Fit fOR The Aged) classification. Age Ageing 45:262–267 CrossRef Wehling M, Burkhardt H, Kuhn-Thiel A et al (2016) VALFORTA: a randomised trial to validate the FORTA (Fit fOR The Aged) classification. Age Ageing 45:262–267 CrossRef
Metadaten
Titel
Post-discharge adjustment of medication in geriatric patients
A prospective cohort study
verfasst von
Dr. Olaf Krause
Stefanie Glaubitz
Klaus Hager
Tanja Schleef
Birgitt Wiese
Ulrike Junius-Walker
Publikationsdatum
22.08.2019
Verlag
Springer Medizin
Erschienen in
Zeitschrift für Gerontologie und Geriatrie
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-019-01601-8