Tags
Acute care, Chronic (medicine), Health, Health care, Hospital, Ontario, St. Michael's Hospital, University of Toronto
Prescriptions slip-ups affecting hospitalized seniors
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.”
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Earl's View 
At the risk of alienation, but fully embracing my’ near-seniorhood,’ we want. thinking long and hard about the plose am of any bote.and First, I feel that we as Americans need to decide what kind of health care. One where Dr. Wlelby makes house calls and his nurse is available 24/7 and he remembers all of our meds and why we take them?
If we chose the case management approach, that close attention to what ails us will gradually go (wasn’t it on the wane, anyway?). Let’s face it, for good/bad/OR JUST SHEER ADVANCEMENT AND CHANGE, medicine moves on.
It might be time for patients to take a bit more responsibility for their own care; like what medications they take and then they taking. Leave the formulas behind and be your own best advocate. Nurses and Doctors can only do so much; isn’t there a place for the patient to become a little involved in his care?
Hi Annie
Yes – I am an advocate of “personal responsibility” too. And sadly i am old enough to get into various senior villages!
The issue I think becomes one about those with diminishing faculties – who may not even be aware of it.
There is more of a failure in our family fabric than the medical system I think?
Many aging parents are resented by their also aging offspring who are busy trying to be 30’s in their 50’s!
So a safety net is needed?
Earl
Yes, a safety net of some sorts is needed, but I think more people are more dependent than they have to be. Yes, when you have the senior who has dementia and isn’t aware, there needs to be, like you say, a personal or professional safety net; but I’m not for the government thinking this is one more area in which it can and SHOULD stick it’s nose, but I agree, a safety net of sorts is needed.
What comes to mine are stringent after discharge care rules, which can easily be given to a specified home care agency who works with that particular physician and monitors the patients for a few weeks to make sure they have a seemless transition from the hospital to the home and all questions are answered.
Yes – agreed.
Earl, I’ll have to go with you on the stats, but for years as a nurse, I saw patients come home from the hospital, not understanding their medication and/or treatment regimen. Well meaning family/friends/neighbors can only go so far in some cases.
I get the feeling you’re in Canada, but not sure. In the US, we have legislation in from of Congress that would establish a National Nurse for Public Health.The National Nurse would work with the Surgeon General to make sure that scenarios like these don’t ‘happen’ and that our seniors get the best of care.
Think of the money, again I don’t know the stats, that could be saved by teaching GRANDMA how to take her meds, before taking them incorrectly, or at double doses proves to be a problem.
Hi Annie – I am in Queensland, Australia.
Understand your points – having been in hospital a few times I have personally experienced conflict between what the hospital doctors want you to take and what your GP wants you to take. Quite often completely opposite – as was the case with my mothers blood pressure med’s.
Earl