Hospital stays can sometimes have unintended consequences that undermine a patient’s long-term chances of survival. A new study has found that a significant number of patients fail to renew prescriptions for their chronic diseases after they are released from hospital.
“When a patient leaves the hospital, the doctor may say, ‘Here is a new list of medications you are on,’ … and the patient may assume it’s okay to stop taking other medications,” explains lead researcher Chaim Bell, a physician at St. Michael’s Hospital in Toronto.
If those other drugs were for a serious illness, the patient may end up back in hospital, or worse, said Dr. Bell, who is also a researcher at the Institute for Clinical Evaluative Sciences.
“It has huge implications for the patient,” he said, adding that these problems largely result from a failure of communication.
The findings are based on 400,000 Ontario residents over the age of 66 who had been prescribed one of five medications for chronic diseases. The drugs included statins for lowering cholesterol; blood thinners for preventing clots; levothyroxine, a hormone replacement for thyroid problems; stomach-acid suppressors for gastric reflux, and inhalers to ease respiratory conditions.
During the study period, from 1997 to 2009, almost half the subjects – 188,000 – were hospitalized, including 16,500 who had been in an intensive-care unit.
The study revealed that 19 per cent of patients did not renew their prescriptions for one of the five medications after being discharged from hospital, and that number rose to almost 23 per cent among those who’d been in an ICU.
Dr. Bell noted that during a hospital stay, all of a patient’s medications are supplied by the hospital pharmacy. But it can be a challenge for medical staff to obtain a complete and accurate list of a patient’s existing medications.
In some cases, a medication may be intentionally stopped because it could interfere with immediate care. For instance, a blood thinner may be temporarily halted because it could lead to excessive bleeding during surgery. Then, patients may be given new prescriptions related to their hospitalization.
Meanwhile, what happened at the hospital may not be properly conveyed to the family physician responsible for long-term care. Patients may have their prescriptions filled at several different pharmacies that don't communicate with each other. To further complicate matters, severally ill patients may not be fully aware of all their treatments. So there are many opportunities for a regular medication to fall off the list.
“It’s a very vulnerable time,” said Dr. Bell. The study, published this week in the Journal of the American Medical Association, highlights the need for better follow-up care.
