Frequency and Predictors of Prescription-related Issues After Hospital Discharge

Sunil Kripalani, MD, MSc; Megan Price, MS; Victoria Vigil, MPH, CHES, CPHQ; Kenneth R. Epstein, MD, MBA

Disclosures

Journal of Hospital Medicine. 2008;3(1):12-19. 

In This Article

Abstract and Introduction

Background: In the period immediately following hospital discharge, patients often experience difficulty with medication management. The problems related to patients' handling of discharge prescriptions are not well characterized.
Methods: We conducted a large observational study of patients discharged from 170 community hospitals in 2005. By combining clinical, administrative, and call center data, we were able to examine independent predictors of prescriptionrelated issues in the 48-72 hours after hospital discharge. Issues included: not picking up prescribed discharge medications, not knowing if these medications had been picked up, not taking discharge medications, and not understanding how to take the medications.
Results: More than half (57.0%) of the 31,199 subjects in the study were women, and the mean age was 61.1 years. Overall, 7.2% of patients (n = 2253) reported prescription-related issues, most often not filling discharge prescriptions. In multivariable analyses, prescription-related issues were more common among adults age 35-49; women; patients with Medicare HMO coverage, Medicaid, or no insurance; adults with higher severity of illness ratings; and patients prescribed 6 or more medications or an inhaler. Predictors of fewer problems were being age 65 or older; having HMO or commercial insurance; being prescribed antibiotics, anticoagulants, or angiotensin II receptor blockers; and having a major diagnosis in the skin or musculoskeletal categories.
Conclusions: About 7% of patients reported prescription-related issues within a few days of hospital discharge. High-risk patients should be identified and offered additional assistance prior to discharge and receive a follow-up phone call to assess if discharge prescriptions have been filled.

The period immediately following hospital discharge is a vulnerable time for patients, who must assume responsibilities for their own care as they return home.[1] The process of hospital discharge may be a rushed event, and patients often have difficulty understanding and following their postdischarge treatment plan.[2,3] Medication-related problems after hospital discharge, which include patients not filling or refilling prescriptions,[4,5,6] not understanding how to take medications,[2,3] showing discrepancies between what they are and what they should be taking,[7,8,9] and having adverse drug events,[10,11,12] are a major cause of morbidity and mortality.[13]

According to prior studies, elderly patients and patients taking more than 5 medications are more likely to experience problems with their medications.[5,14] Adverse drug events are more common with certain high-risk drugs, including cardiovascular agents, anticoagulants, insulin, antibiotics, and steroids.[11,14,15] Beyond this, however, patient management of prescription medications after hospital discharge has not been well described. In particular, studies in the community setting and in the immediate postdischarge period are needed.

We conducted a large observational study of patients at 170 community hospitals in order to examine the frequency of prescription-related issues 48-72 hours after hospital discharge. These issues included problems with filling or taking medications prescribed at discharge. We hypothesized that age and number of medications would be independently associated with prescription-related problems. We also examined the effects of other factors, including insurance type, length of stay, severity of illness (SOI), clinical diagnosis, and use of certain high-risk drugs.

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