Mainstay Meds Often Cut Off Accidentally After Hospital Stay

TUESDAY Aug. 23, 2011 -- Many patients who are hospitalized fail to receive their regular medications for chronic conditions during their stay and often fail to restart them when they're discharged, researchers say.

Patients treated in the intensive care unit (ICU) are even less likely to resume their regular medication schedule after discharge, probably because there are so many "transitions of care" to different units within the hospital and so many different care teams involved, the study found.

"Sometimes we do a pretty good job of taking care of people in the hospital, but we don't do a great job of making the transition back to the community," said Dr. Chaim Bell, lead author of a study published in the Aug. 24/31 issue of the Journal of the American Medical Association. "That can lead to whole host of problems."

Unintended discontinuation of vital medications can lead to another hospital stay or even death, Bell said.

Bell, an associate professor of medicine and of health policy, management and evaluation at the University of Toronto/St. Michael's Hospital, looked at medical records on almost 400,000 elderly patients in Ontario who were taking at least one of five types of medication for a chronic condition: statins to lower cholesterol, blood thinners, levothyroxine to treat underactive thyroid, respiratory inhalers or drugs to reduce stomach acid.

All patients had faithfully filled their prescriptions for at least a year before being hospitalized.

The patients were divided into three groups: those hospitalized in the ICU, those hospitalized in a part of the hospital other than the ICU and patients who weren't hospitalized at all.

Hospitalized patients were more likely to discontinue their medication after release, no matter which drug they were taking.

For instance, patients taking levothyroxine were 18 percent more likely than non-hospitalized patients to stay off the drug, while patients taking blood thinners were 86 percent more likely to discontinue use.

Rates were even higher for patients who left the ICU. Those taking statins before an ICU stay were 48 percent more likely to be off them 90 days after discharge compared with nonhospitalized patients, while people taking blood thinners were more than twice as likely to discontinue use.

When comparing ICU patients to other hospitalized patients, the researchers said the ICU group had 11 percent higher odds of discontinuing statins, 25 percent greater odds for blood thinners and 29 percent for levothyroxine.

One reason that patients leaving the ICU were less likely to get back on their potentially lifesaving medications has to do with the nature of emergency care. "The deliberate suspension of certain medicatins for resuscitation is often required, which may later be forgotten or overlooked upon discharge," the study authors wrote.

The risk of stopping medications varies, and the study found that those who stopped taking statins had a 7 percent increased risk of dying, visiting the emergency room or rehospitalization within a year after their initial visit, while those who stopped taking blood thinners had a 10 percent increased risk of serious illness or death.

The researchers said it's unclear why the medications are stopped in the hospital, but it's generally either from ignorance or error. They believe most cases of discontinuation were unintentional.

Considering that hospitalized patients are prescribed an average of 12 different medications in the year before their stay, the issue is complex.

To make sure patients go home with the right prescriptions, Bell said communication among all facets of the multidisciplinary care team and better follow-up with the patients' primary care providers are key.

"All parts in the multidisciplinary team are part of the information loop. We can't just send someone to the pharmacist without the pharmacist knowing what happened in the hospital," he said. "It seems increasingly that interventions should also include things in the community."

Patients need to be included in the follow-up plan, too.

"These numbers give us a baseline, a place to start," said Libby Dodds- Ashley, associate director of clinical pharmacy services at the University of Rochester Medical Center in New York, who also pointed out that initiatives in Europe and elsewhere which use this multidisciplinary approach have had "positive results."

More information

The U.S. National Library of Medicine has more on safe medication practices.

Posted: August 2011


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