Document Detail

Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases.
MedLine Citation:
PMID:  21862745     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Patients discharged from acute care hospitals may be at risk for unintentional discontinuation of medications prescribed for chronic diseases. The intensive care unit (ICU) may pose an even greater risk because of the focus on acute events and the presence of multiple transitions in care.
OBJECTIVE: To evaluate rates of potentially unintentional discontinuation of medications following hospital or ICU admission.
DESIGN, SETTING, AND PATIENTS: A population-based cohort study using administrative records from 1997 to 2009 of all hospitalizations and outpatient prescriptions in Ontario, Canada; it included 396,380 patients aged 66 years or older with continuous use of at least 1 of 5 evidence-based medication groups prescribed for long-term use: (1) statins, (2) antiplatelet/anticoagulant agents, (3) levothyroxine, (4) respiratory inhalers, and (5) gastric acid-suppressing drugs. Rates of medication discontinuation were compared across 3 groups: patients admitted to the ICU, patients hospitalized without ICU admission, and nonhospitalized patients (controls). Odds ratios (ORs) were calculated and adjusted for patient demographics, clinical factors, and health services use.
MAIN OUTCOME MEASURES: The primary outcome was failure to renew the prescription within 90 days after hospital discharge.
RESULTS: Patients admitted to the hospital (n = 187,912) were more likely to experience potentially unintentional discontinuation of medications than controls (n = 208,468) across all medication groups examined. The adjusted ORs (AORs) ranged from 1.18 (95% CI, 1.14-1.23) for discontinuing levothyroxine in 12.3% of hospitalized patients (n = 6831) vs 11.0% of controls (n = 7114) to an AOR of 1.86 (95% CI, 1.77-1.97) for discontinuing antiplatelet/anticoagulant agents in 19.4% of hospitalized patients (n = 5564) vs 11.8% of controls (n = 2535). With ICU exposure, the AORs ranged from 1.48 (95% CI, 1.39-1.57) for discontinuing statins in 14.6% of ICU patients (n = 1484) to an AOR of 2.31 (95% CI, 2.07-2.57) for discontinuing antiplatelet/anticoagulant agents in 22.8% of ICU patients (n = 522) vs the control group. Admission to an ICU was associated with an additional risk of medication discontinuation in 4 of 5 medication groups vs hospitalizations without an ICU admission. One-year follow-up of patients who discontinued medications showed an elevated AOR for the secondary composite outcome of death, emergency department visit, or emergent hospitalization of 1.07 (95% CI, 1.03-1.11) in the statins group and of 1.10 (95% CI, 1.03-1.16) in the antiplatelet/anticoagulant agents group.
CONCLUSIONS: 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.
Chaim M Bell; Stacey S Brener; Nadia Gunraj; Cindy Huo; Arlene S Bierman; Damon C Scales; Jana Bajcar; Merrick Zwarenstein; David R Urbach
Related Documents :
22045625 - Out-of-hospital cardiac arrest: recent advances in resuscitation and effects on outcome.
21682175 - Pas in the ed: do physicians think they increase the malpractice risk?
21751755 - Fatal adverse events during hospital stays.
21621315 - Outcomes following military traumatic cardiorespiratory arrest: a prospective observati...
11873385 - A method for identifying the financial burden of hospitalized infants on families.
1422525 - A psychodynamic approach to the master treatment plan.
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA     Volume:  306     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-08-24     Completed Date:  2011-08-25     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  840-7     Citation Subset:  AIM; IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Aged, 80 and over
Chronic Disease / drug therapy*
Cohort Studies
Continuity of Patient Care*
Drug Therapy / utilization
Hospitalization / statistics & numerical data
Hospitals / statistics & numerical data
Intensive Care Units*
Medication Adherence*
Medication Errors*
Odds Ratio
Outcome Assessment (Health Care)
Patient Admission*
Prescriptions / statistics & numerical data*
Grant Support
67113//Canadian Institutes of Health Research
Comment In:
JAMA. 2011 Aug 24;306(8):878-9   [PMID:  21862750 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Effect of a dietary portfolio of cholesterol-lowering foods given at 2 levels of intensity of dietar...
Next Document:  Automated identification of postoperative complications within an electronic medical record using na...