Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases
JAMA, Volume 306, No. 8, Year 2011
Notification
URL copied to clipboard!
Description
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. ©2011 American Medical Association. All rights reserved.
Authors & Co-Authors
Bell, Chaim M.
Canada, Toronto
University of Toronto
Canada, Toronto
Saint Michael's Hospital University of Toronto
Canada, Toronto
Institute for Clinical Evaluative Sciences
Gunraj, Nadia
Canada, Toronto
Institute for Clinical Evaluative Sciences
Bierman, Arlene S.
Canada, Toronto
University of Toronto
Canada, Toronto
Institute for Clinical Evaluative Sciences
Scales, Damon C.
Canada, Toronto
University of Toronto
Canada, Toronto
Institute for Clinical Evaluative Sciences
Canada, Toronto
Sunnybrook Health Sciences Centre
Zwarenstein, Merrick F.
Canada, Toronto
University of Toronto
Canada, Toronto
Institute for Clinical Evaluative Sciences
Statistics
Citations: 216
Authors: 5
Affiliations: 4
Identifiers
Doi:
10.1001/jama.2011.1206
ISSN:
00987484
Research Areas
Health System And Policy
Study Design
Randomised Control Trial
Cross Sectional Study
Cohort Study
Study Approach
Quantitative