Chronic medications and hospitalization

Your patients' chronic medications may be inadvertently discontinued after hospitalization according to a population-based cohort study of almost 400,000 patients published recently in the Journal of the American Medical Association. Researchers from Canada reviewed the records of residents age 66 or older who were on statins, antiplatelet/anticoagulant agents, levothyroxine, respiratory inhalers, or gastric acid suppressing drugs on a chronic basis. When compared to nonhospitalized patients, patients admitted to the hospital — especially the ICU — were more likely to have their chronic medications discontinued. Discontinuation rates ranged from a low for levothyroxine of 12.3% discontinuation for hospitalizations vs 11% for controls, to antiplatelet/anticoagulant agents which were discontinued at a rate of 19.4% for hospitalizations vs 11.8% for controls. The discontinuation rates were even higher for patients who were admitted to the ICU. The authors conclude that patients admitted to the hospital are at relatively high risk for potential unintentional discontinuation of chronic medications (JAMA 2011;306:840-847). This study points out the importance of medication reconciliation at all post-hospital visits and may validate the role of computerized medical records, especially with regard to medication lists.