Hospital stays linked to higher risk of incorrect drug prescriptions

Almost half of older patients are exposed to potentially inappropriate prescribing each year, and the problem gets worse when they are hospitalised, according to Irish research published in The BMJ.

Older patients who were hospitalised were 72 per cent more likely to be given a potentially inappropriate prescription after their admission, independent of other patient factors, the study found.

Inappropriate prescribing covers issues such as the intensification of existing drugs and the failure to stop or reduce doses of certain drugs after discharge from hospital.

The findings suggest that better coordination of care is needed to reduce avoidable medication related harms among these patients and that hospital admission is a big driver of the overuse and misuse of drugs.

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Potentially inappropriate prescribing is common among older adults and is associated with adverse outcomes including emergency hospital attendances and admissions, adverse drug events and poorer quality of life.

Up to now, research has focused on the characteristics of patients and general practitioners as risk factors for poor prescribing quality. "There has been less focus on how health system factors, such as hospital admission or care transitions, may contribute to the appropriateness of prescribing for these patients," according to Dr Frank Moriarty, senior research fellow at the Royal College of Surgeons in Ireland (RCSI).

The researchers, led by Tom Fahey at the RCSI, in collaboration with Complutense University of Madrid, analysed data from 44 general practices in Ireland from 2012 to 2015. A total of 38,229 patients living in the community were included in the analyses.

The overall level of potentially inappropriate prescribing ranged from 45.3 per cent of patients in 2012 to 51 per cent in 2015.

Irrespective of age, sex, number of prescription items, other conditions, and health cover, hospital admission was associated with a higher rate of potentially inappropriate prescribing.

And among participants who were admitted to hospital, the likelihood of potentially inappropriate prescribing after admission was consistently higher than before admission, even after controlling for patients’ characteristics.

Many of the common criteria in the study related to the inappropriate duration of use of medicines used for sleep, acid suppression, and anti-inflammatory effect, Dr Moriarty said.

The study, which was funded by the Health Research Board, is observational, so no firm conclusions can be drawn about cause and effect.