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Unintended discontinuation of medication following hospitalisation: a retrospective cohort study
  1. Patrick Redmond1,2,
  2. Ronald McDowell1,3,
  3. Tamasine C Grimes4,
  4. Fiona Boland1,
  5. Ronan McDonnell1,
  6. Carmel Hughes5,
  7. Tom Fahey1
  1. 1 HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
  2. 2 School of Population Health and Environmental Sciences, King’s College London, London, UK
  3. 3 Centre for Public Health, Queen’s University, Cancer Epidemiology and Health Services Group, Belfast, UK
  4. 4 School of Pharmacy, Trinity College Dublin, Dublin, Ireland
  5. 5 School of Pharmacy, Queens University Belfast, Belfast, UK
  1. Correspondence to Dr Patrick Redmond; predmond{at}rcsi.ie

Abstract

Objectives Whether unintended discontinuation of common, evidence-based, long-term medication occurs after hospitalisation; what factors are associated with unintended discontinuation; and whether the presence of documentation of medication at hospital discharge is associated with continuity of medication in general practice.

Design Retrospective cohort study between 2012 and 2015.

Setting Electronic records and hospital supplied discharge notifications in 44 Irish general practices.

Participants 20 488 patients aged 65 years or more prescribed long-term medication for chronic conditions.

Primary and secondary outcomes Discontinuity of four evidence-based medication drug classes: antithrombotic, lipid-lowering, thyroid replacement drugs and respiratory inhalers in hospitalised versus non-hospitalised patients; patient and health system factors associated with discontinuity; impact of the presence of medication in the hospital discharge summary on continuity of medication in a patient’s general practitioner (GP) prescribing record at 6 months follow-up.

Results In patients admitted to hospital, medication discontinuity ranged from 6%–11% in the 6 months posthospitalisation. Discontinuity of medication is significantly lower for hospitalised patients taking respiratory inhalers (adjusted OR (AOR) 0.63, 95% CI (0.49 to 0.80), p<0.001) and thyroid medications (AOR 0.62, 95% CI (0.40 to 0.96), p=0.03). There is no association between discontinuity of medication and hospitalisation for antithrombotics (AOR 0.95, 95% CI (0.81 to 1.11), p=0.49) or lipid lowering medications (AOR 0.92, 95% CI (0.78 to 1.08), p=0.29). Older patients and those who paid to see their GP were more likely to experience increased odds of discontinuity in all four medicine groups. Less than half (39% to 47.4%) of patients had medication listed on their hospital discharge summary. Presence of medication on hospital discharge summary is significantly associated with continuity of medication in the GP prescribing record for lipid lowering medications (AOR 1.64, 95% CI (1.15 to 2.36), p=0.01) and respiratory inhalers (AOR 2.97, 95% CI (1.68 to 5.25), p<0.01).

Conclusion Discontinuity of evidence-based long-term medication is common. Increasing age and private medical care are independently associated with a higher risk of medication discontinuity. Hospitalisation is not associated with discontinuity but less than half of hospitalised patients have medication recorded on their hospital discharge summary.

  • transitions of care
  • medication reconciliation
  • continuity of patient care
  • cohort study

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors PR initiated the project, designed data collection tools, monitored data collection, wrote the statistical analysis plan, cleaned and analysed the data, and drafted and revised the paper. RMcDowell wrote the statistical analysis plan, cleaned and analysed the data and revised the paper. TCG designed the data collection tools, wrote the statistical analysis plan and revised the paper. FB designed the data collection tools, wrote the statistical analysis plan and revised the paper. RMcDonnell designed the data collection tools and revised the paper. CH initiated the project, advised on the statistical analysis plan and revised the paper. TF initiated the project, monitored data collection, advised on the analysis plan and revised the paper, and is the guarantor.

  • Funding This study was funded by the Health Research Board of Ireland, HRC-2014-1. This work was conducted as part of the HRB Scholar Programme in Health Services Research under Grant No. PHD/2007/16.

  • Competing interests None declared.

  • Ethics approval Ethical approval was granted from the Irish College of General Practitioners’ Research Ethics Committee. GPs as individual practice data controllers gave informed consent to participate.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data is available. A data sharing provision was not included in the application to the research ethics committee for approval of this study.

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