Hospital admission may lead patients to unintentionally discontinue medications for chronic diseases

September 9, 2011

Patients discharged from the hospital are at an elevated risk of not continuing their long-term medications for chronic diseases, and ICU admission appears to further increase this risk, according a recent study published August 24 in the Journal of the American Medical Association.

Patients discharged from the hospital are at an elevated risk of not continuing their long-term medications for chronic diseases, and ICU admission appears to further increase this risk, according a recent study published August 24 in the Journal of the American Medical Association.

Downstream effects of the unintentional discontinuation of some medications may include an increased adjusted risk of death, emergency department visit, and hospitalization, the study showed.

To evaluate rates of patients unintentionally discontinuing medications on discharge from an acute hospital or ICU admission, researchers used administrative records from 1997 to 2009 of all hospitalizations and outpatient prescriptions in Ontario, Canada, to select a cohort of patients aged 66 years and older with continuous use of at least 1 of 5 evidence-based medication groups prescribed for long-term use: (1) statins, (2) antiplatelet/anticoagulant agents, (3) levothyroxine, (4) respiratory inhalers, and (5) gastric acid-suppressing drugs. Researchers selected these medication groups because their discontinuation has been associated with adverse events.

The population-based study included 396,380 patients for which rates of medication discontinuation were compared across 3 groups: patients admitted to the ICU (16,474), patients hospitalized without ICU admission (171,438), and nonhospitalized patients (208,468 controls). The primary outcome was defined as no prescription renewal in the Ontario Drug Benefits database 90 days after the index date.

Patients admitted to the hospital (n=187,912) were more likely than controls to experience potentially unintentional discontinuation of medications across all 5 medication groups. 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. The highest rate of medication discontinuation occurred in the antiplatelet or anticoagulant agent group (n=5,564; 19.4%). The respiratory inhaler group had the lowest rate of medication discontinuation (n=231; 4.5%). Of the patients who discontinued medication, 5.4% were in the ICU admission group (n=20) compared with 3% in the control group (n=79).

Following analysis of the primary outcome at 90 days, patients were followed from day 91 through day 365 to assess secondary outcomes, which included death, emergency department visit, and emergent hospitalization. Compared patients who had continuous prescriptions, researchers found that patients who experienced discontinuation of statins had a higher risk of these adverse events (adjusted odds ratio [AOR], 1.07; 95% CI, 1.03–1.11), as did patients who discontinued antiplatelet or anticoagulant medications (AOR, 1.10; 95% CI, 1.03–1.16).

“Our present findings have broad implications in that they identify an elevated risk for medication discontinuation across all tested medication groups and all areas of the hospital,” the authors wrote. “These findings emphasize the importance of a systematic approach to transitions in health care to ensure medication continuity. In this way, success in the management of hospitalized patients can translate into success in the management of community patients,” the authors concluded.