Unintentional discontinuation of chronic medications during hospital stays

January 01, 0001

Unintentional discontinuation of chronic medications during hospital stays

These Canadian researchers examined potentially unintentional discontinuation of chronic medications following hospital or ICU admission. They performed a population-based cohort study utilizing administrative records of all hospitalizations and ambulatory prescriptions for patients over the age of 65 in Ontario, Canada (396 380 patients). Specifically, they looked at 5 evidence-based medication groups: statins, antiplatelet/anticoagulant agents, levothyroxine, pulmonary inhalers, and gastric acid-suppressing drugs. They compared the rates of discontinuation of medication among patients admitted to the ICU, patients hospitalized intensive care, and nonhospitalized patients (controls).

The researchers found: "Patients admitted to the hospital (n = 187 912) were more likely to experience potentially unintentional discontinuation of medications than controls (n = 208 468) across all medication groups examined. The adjusted ORs (AORs) ranged from 1.18 for discontinuing levothyroxine in 12.3% of hospitalized patients (n = 6831) vs 11.0% of controls (n = 7114) to an AOR of 1.86 for discontinuing antiplatelet/anticoagulant agents in 19.4% of hospitalized patients (n = 5564) vs 11.8% of controls (n = 2535). With ICU exposure, the AORs ranged from 1.48 for discontinuing statins in 14.6% of ICU patients (n = 1484) to an AOR of 2.31 for discontinuing antiplatelet/anticoagulant agents in 22.8% of ICU patients (n = 522) vs the control group. Admission to an ICU was associated with an additional risk of medication discontinuation in 4 of 5 medication groups vs hospitalizations without an ICU admission. One-year follow-up of patients who discontinued medications showed an elevated AOR for the secondary composite outcome of death, emergency department visit, or emergent hospitalization of 1.07 in the statins group and of 1.10 in the antiplatelet/anticoagulant agents group."

The researchers concluded: "Patients prescribed medications for chronic diseases were at risk for potentially unintentional discontinuation after hospital admission. Admission to the ICU was generally associated with an even higher risk of medication discontinuation."

This study reinforces the importance of followup with primary care physicians following hospitalization to ensure proper continuation of chronic medications

For the full abstract, click here.

JAMA 306(8):840-847, 24 August 2011 © 2011 American Medical Association
Association of ICU or Hospital Admission With Unintentional Discontinuation of Medications for Chronic Diseases. Chaim M. Bell, Stacey S. Brener, Nadia Gunraj, et al.

Category: A. Generalized/Unspecified. Keywords: ICU, hospitalization, chronic, medications, discontinuation, population-based cohort study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 6 September 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.