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Prescriptions slip-ups affecting hospitalized seniors

Published On Tue Aug 23 2011 Theresa Boyle Health Reporter
 Source: thestar.com

Too many seniors are discharged from hospital without getting prescriptions renewed, causing them to get sicker and needlessly putting pressure on Ontario’s cash-strapped health system, new research shows.

As many as 19 per cent of seniors who had been taking medication for chronic conditions for at least a year before being hospitalized in acute care units failed to continue to take the drugs after being sent home, according to research published Tuesday in the Journal of the American Medical Association.

For patients who spent time in intensive care, that number rose to nearly 23 per cent, says the study by researchers at St. Michael’s Hospital and the Institute for Clinical and Evaluative Sciences.

“We were surprised by the findings. We definitely had anecdotal evidence of this happening … but we were surprised by the breadth of it,” said lead researcher Dr. Chaim Bell, a staff physician at St. Mike’s and associate professor of medicine at the University of Toronto.

Bell and is team analyzed data for 197,912 Ontario residents over age 65 who had been hospitalized between 1997 and 2009. Of those, 16,474 had been admitted to intensive care units. Prior to hospitalization, they had been taking one of five common medications for chronic diseases. The drugs included statins for lowering cholesterol, anticoagulants to prevent blood clots, hormone replacements for thyroid problems, respiratory inhalers and gastric-acid suppressants.

The highest rate of discontinuance was for anticoagulants — 19.4 per cent for patients who had been in acute care and 22.8 per cent for those who had been in intensive care.

The lowest rate of discontinuance was for respiratory inhalers — 4.5 per cent of patients who had been in acute care and 5.4 per cent of those who had been in intensive care.

“If you don’t continue your medication after hospital, that can have consequences such as hospital readmissions, visits to them emergency department and, in rare cases, death,” Bell said.

Medication regimens for chronic conditions are often suspended in intensive care units where treatment is focused on the emergency conditions that land patients there. Resumption of those regimens can be forgotten or overlooked by doctors, staff in hospitals or long-term care facilities and even patients themselves, Bell said.

And when patients are transferred between the ICU, hospital ward and home, errors can occur during the hand-off and prescriptions don’t get renewed, he explained.

Bell said the findings point to the need for better communication between hospitals, primary care providers, patients and family members. As well, improved electronic or paper records would ensure continuity of care.

Bell said the findings should be of interest to policy-makers and taxpayers because “avoidable hospitalizations are a huge issue now in health care.”