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Drug changes at the interface between primary and secondary care.
W Himmel1, M M Kochen, U Sorns
1Department of General Practice, University of Göttingen, Göttingen, Germany. whimmel@gwdg.de
Summary
Hospitalization frequently leads to significant medication changes, with most patients experiencing alterations to their drug regimens. This highlights a need for careful review of hospital drug policies to ensure patient safety and continuity of care.
Area of Science:
- Internal Medicine
- Pharmacology
- Patient Safety
Background:
- Hospitalization often necessitates medication adjustments.
- General practitioners (GPs) prescribe chronic medications for patients with various conditions.
- Understanding drug changes during hospital stays is crucial for patient care.
Purpose of the Study:
- To determine the frequency of medication changes in patients referred to hospital from general practice.
- To identify factors associated with these drug changes.
Main Methods:
- Observational study involving a chart review of 300 patients with chronic diseases across three German hospitals.
- Recorded frequency of drug cancellation, replacement, dosage alteration, manufacturer change, and initiation of new treatments.
Main Results:
- Half of GP-prescribed chronic medications (644/1,330) were continued in hospital; 36% were canceled.
- Hospital staff newly prescribed 724 of 1,572 total medications.
- Over 60% of patients (184/300) had three or more medication regimen changes during hospitalization.
- No significant difference in drug cancellation rates for antihypertensive and cardiac drugs based on referral reason.
Conclusions:
- Nearly all hospitalized patients experience some form of medication change.
- High rates of change affect medications for conditions unrelated to the reason for hospitalization.
- Hospital drug policies should prioritize continuing existing regimens when medically appropriate and discourage unnecessary changes to GP-prescribed medications.