Patients at risk for medication stoppage

According to a report1 from the The Journal of the American Medical Association (JAMA), patients discharged from acute care hospitals might be at risk for unintentional discontinuation of medications prescribed for chronic diseases. The report says that the intensive care unit (ICU) might pose an even greater risk because of the focus on acute events and the presence of multiple transitions in care.

The population-based cohort study used administrative records from 1997 to 2009 of all hospitalizations and outpatient prescriptions in Ontario, Canada. The researchers studied patients aged 66 years or older with continuous use of at least one of five evidence-based medication groups prescribed for long-term use, including statins, antiplatelet/anticoagulant agents, levothyroxine, respiratory inhalers, and gastric acid–suppressing drugs.

Rates of medication discontinuation were compared across three groups: patients admitted to the ICU, patients hospitalized without ICU admission, and non-hospitalized patients.

Researchers found that patients admitted to the hospital were more likely to experience potentially unintentional discontinuation of medications across all medication groups examined. Admission to an ICU was associated with an additional risk of medication discontinuation in four of five medication groups vs. hospitalizations without an ICU admission.

One-year follow-up of patients who discontinued medications showed an elevated adjusted OR for the secondary outcome of death, emergency department visit, or emergent hospitalization in the antiplatelet/anticoagulant agents group.

Researchers concluded that 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.

Reference

  1. Bell C, Brener S, Gunraj N. Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases. JAMA 2011; 306:840-847.