A recent study of almost 400,000 Ontario hospital patients showed that there was a significant risk that these patients would discontinue taking vital meds after discharge.
This extremely well-designed study tracked elderly patients who were on at least 1 of 5 medications for chronic diseases - statins, anti-coagulants, inhalers for respiratory diseases, thyroid medications and gastric acid-suppressing drugs - both with ICU and without ICU hospital admission. Upon discharge more than 19% of patients did not renew these vital prescriptions in the three months after leaving the hospital. For those admitted to the ICU, this number increased to 23%. Not surprisingly, within one year, there was a significant risk of hospitalization or death for these patients who discontinued their medications.
The authors of the study theorize that " transitions in care are vulnerable periods for patients during hospitalization. Medical errors during this period can occur as a result of incomplete or inaccurate communication as responsibility shifts from one physician to another."
Another contributing factor may also be that, during the hospital stay, the patient is relieved of the responsibility of taking the right meds at the right time as this is handled automatically by the nursing staff. In other words, they forget and/or get out of the routine. When they return home after a hospital stay, there may be other medications that have been added which they may believe has replaced their previous meds. In any event, the hospital stay, particularly if it involved ICU, is a watershed event that may create confusion or at least a sense of the beginning of a new lifestyle.
Obviously hospitals must institute better discharge procedures and introduce technology that will track medical records more effectively. But this is a wake-up call for those responsible for the homecare of discharged seniors - family doctors, relatives and caregivers. It is essential to understand and ensure the medications that a post-operative patient is taking are the correct ones.
Even more importantly, this study speaks to the importance of families and caregivers keeping accurate, up-to-date and easily accessible records for a loved one. This record should accompany the patient at the time of hospital admission (emergency or otherwise). It is understandable that hospital personnel may not have the inclination to try to rebuild a medication profile and so they start from scratch. It is not surprising therefore that many medications are discontinued after a hospital stay.