The Need for Ensuring Medication Continuity

Discontinuation of medications with proven efficacy for treating chronic diseases is a critical problem, especially during or following hospitalization. Research has suggested that transitions in care, specifically those that occur during an ICU admission, may be partly to blame because they can result in medical errors. Examining Transitions in Care In a study published in the August 2011 JAMA, Chaim M. Bell, MD, PhD, and colleagues set out to evaluate rates of unintentional discontinuation of medication following hospitalization. Rates of medication discontinuation were compared across three groups: 1) patients admitted to the ICU, 2) patients hospitalized without ICU admission, and 3) non-hospitalized patients (controls). “We evaluated the effect of hospitalization and ICU admission on discontinuation of five medication groups with strong benefit-to-risk ratios,” explains Dr. Bell. “This is also one of the first studies to our knowledge that assesses the impact of discontinuation on outcomes at 1 year after discharge.” Dr. Bell’s population-based cohort study analyzed medical records on almost 400,000 elderly patients hospitalized between 1997 and 2009 who were taking at least one of five medications: Statins. Antiplatelet or anticoagulant agents. Levothyroxine. Respiratory inhalers. Gastric acid–suppressing drugs. Patients were required to demonstrate a minimum of 1 year of continuous use of the medication for study entry, thus minimizing the possibility of deliberate medication withdrawals. At 90 days after study participants were discharged, potentially unintentional discontinuation of medication was assessed. The authors also tracked deaths, hospitalizations, and ED visits up to 1 year after hospital discharge. New Findings on Medication Discontinuation In the JAMA article, the investigators found that hospitalization was associated with an increased risk of medication discontinuation...