Abstract
We assessed the prescriptions of patients hospitalized in a geriatric unit and subsequently discharged. This prospective and observational study was conducted over a two-month period in the geriatrics department (acute and rehabilitation units) of a university hospital. Patients discharged from this department were included over a two-month period. Prescriptions were analyzed at admission and discharge from the geriatrics department (DGD), and six weeks after DGD. We included 209 patients, 63% female, aged 86.8 years. The mean number of medications prescribed was significantly higher at DGD than at admission (7.8 vs. 7.1, p = 0.003). During hospitalization, 1217 prescriptions were changed (average 5.8 medications/patient): 52.8% were initiations, 39.3% were discontinuations, and 7.9% were dose adjustments. A total of 156 of the 209 patients initially enrolled completed the study. Among these patients, 81 (51.9%) had the same prescriptions six weeks after DGD. In univariate analysis, medications were changed more frequently in patients with cognitive impairment (p = 0.04) and in patients for whom the hospital report did not indicate in-hospital modifications (p = 0.007). Multivariate analysis found that six weeks after DGD, there were significantly more drug changes for patients for whom there were changes in prescription during hospitalization (p < 0.001). A total of 169 medications were changed (mean number of medications changed per patient: 1.1): 52.7% discontinuations, 34.3% initiations, and 13% dosage modifications. The drug regimens were often changed during hospitalization in the geriatrics department, and a majority of these changes were maintained six weeks after DGD. Improvements in patient adherence and hospital-general practitioner communication are necessary to promote continuity of care and to optimize patient supervision after hospital discharge.
Highlights
The multimorbidity of people aged 80 years or more [1] complicates the work of health professionals and the organization of care [2]
Hospitalization is an opportunity for the care team to re-evaluate the prescriptions of individuals in their care, and it has been shown that hospitalization in an acute geriatrics unit (AGU) can reduce the prevalence of inappropriate medication use [6,7]
We found that clinical decompensation (26.0%), miscommunication between the primary sector and the hospital (17.8%), patient request (40.8%), inappropriateness of prescription and occurrence of side effects were the reasons for drug changes six weeks after discharge from the geriatrics department (DGD)
Summary
The multimorbidity of people aged 80 years or more [1] complicates the work of health professionals and the organization of care [2]. Hospitalization is an opportunity for the care team to re-evaluate the prescriptions of individuals in their care, and it has been shown that hospitalization in an acute geriatrics unit (AGU) can reduce the prevalence of inappropriate medication use [6,7]. Once a patient has been hospitalized, the care team will generally analyze the existing prescriptions and modify the drug regimens as appropriate [8]. In order to secure the transition between primary and secondary care and to promote care continuity, medication reconciliation has been developed. It is the process of comparing a patient’s required medication to all of the medication that he/she has been taking, and it has been developed to avoid errors such as omission, duplication, dosing errors and drug interactions [9]
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