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Impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in England

BACKGROUND: Little is known about the impact of hospitalisation on prescribing in UK clinical practice. AIM: To investigate whether an emergency hospital admission drives increases in polypharmacy and potentially inappropriate prescriptions (PIPs). DESIGN AND SETTING: A retrospective cohort analysis...

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Autores principales: Denholm, Rachel, Morris, Richard, Purdy, Sarah, Payne, Rupert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Royal College of General Practitioners 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141815/
https://www.ncbi.nlm.nih.gov/pubmed/32253190
http://dx.doi.org/10.3399/bjgp20X709385
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author Denholm, Rachel
Morris, Richard
Purdy, Sarah
Payne, Rupert
author_facet Denholm, Rachel
Morris, Richard
Purdy, Sarah
Payne, Rupert
author_sort Denholm, Rachel
collection PubMed
description BACKGROUND: Little is known about the impact of hospitalisation on prescribing in UK clinical practice. AIM: To investigate whether an emergency hospital admission drives increases in polypharmacy and potentially inappropriate prescriptions (PIPs). DESIGN AND SETTING: A retrospective cohort analysis set in primary and secondary care in England. METHOD: Changes in number of prescriptions and PIPs following an emergency hospital admission in 2014 (at admission and 4 weeks post-discharge), and 6 months post-discharge were calculated among 37 761 adult patients. Regression models were used to investigate changes in prescribing following an admission. RESULTS: Emergency attendees surviving 6 months (N = 32 657) had a mean of 4.4 (standard deviation [SD] = 4.6) prescriptions before admission, and a mean of 4.7 (SD = 4.7; P<0.001) 4 weeks after discharge. Small increases (<0.5) in the number of prescriptions at 4 weeks were observed across most hospital specialties, except for surgery (−0.02; SD = 0.65) and cardiology (2.1; SD = 2.6). The amount of PIPs increased after hospitalisation; 4.0% of patients had ≥1 PIP immediately before pre-admission, increasing to 8.0% 4 weeks post-discharge. Across hospital specialties, increases in the proportion of patients with a PIP ranged from 2.1% in obstetrics and gynaecology to 8.0% in cardiology. Patients were, on average, prescribed fewer medicines at 6 months compared with 4 weeks post-discharge (mean = 4.1; SD = 4.6; P<0.001). PIPs decreased to 5.4% (n = 1751) of patients. CONCLUSION: Perceptions that hospitalisation is a consistent factor driving rises in polypharmacy are unfounded. Increases in prescribing post-hospitalisation reflect appropriate clinical response to acute illness, whereas decreases are more likely in patients who are multimorbid, reflecting a focus on deprescribing and medicines optimisation in these individuals. Increases in PIPs remain a concern.
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spelling pubmed-71418152020-04-13 Impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in England Denholm, Rachel Morris, Richard Purdy, Sarah Payne, Rupert Br J Gen Pract Research BACKGROUND: Little is known about the impact of hospitalisation on prescribing in UK clinical practice. AIM: To investigate whether an emergency hospital admission drives increases in polypharmacy and potentially inappropriate prescriptions (PIPs). DESIGN AND SETTING: A retrospective cohort analysis set in primary and secondary care in England. METHOD: Changes in number of prescriptions and PIPs following an emergency hospital admission in 2014 (at admission and 4 weeks post-discharge), and 6 months post-discharge were calculated among 37 761 adult patients. Regression models were used to investigate changes in prescribing following an admission. RESULTS: Emergency attendees surviving 6 months (N = 32 657) had a mean of 4.4 (standard deviation [SD] = 4.6) prescriptions before admission, and a mean of 4.7 (SD = 4.7; P<0.001) 4 weeks after discharge. Small increases (<0.5) in the number of prescriptions at 4 weeks were observed across most hospital specialties, except for surgery (−0.02; SD = 0.65) and cardiology (2.1; SD = 2.6). The amount of PIPs increased after hospitalisation; 4.0% of patients had ≥1 PIP immediately before pre-admission, increasing to 8.0% 4 weeks post-discharge. Across hospital specialties, increases in the proportion of patients with a PIP ranged from 2.1% in obstetrics and gynaecology to 8.0% in cardiology. Patients were, on average, prescribed fewer medicines at 6 months compared with 4 weeks post-discharge (mean = 4.1; SD = 4.6; P<0.001). PIPs decreased to 5.4% (n = 1751) of patients. CONCLUSION: Perceptions that hospitalisation is a consistent factor driving rises in polypharmacy are unfounded. Increases in prescribing post-hospitalisation reflect appropriate clinical response to acute illness, whereas decreases are more likely in patients who are multimorbid, reflecting a focus on deprescribing and medicines optimisation in these individuals. Increases in PIPs remain a concern. Royal College of General Practitioners 2020-04-07 /pmc/articles/PMC7141815/ /pubmed/32253190 http://dx.doi.org/10.3399/bjgp20X709385 Text en ©The Authors http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This article is Open Access: CC BY-NC 4.0 licence (http://creativecommons.org/licences/by-nc/4.0/).
spellingShingle Research
Denholm, Rachel
Morris, Richard
Purdy, Sarah
Payne, Rupert
Impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in England
title Impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in England
title_full Impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in England
title_fullStr Impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in England
title_full_unstemmed Impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in England
title_short Impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in England
title_sort impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in england
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141815/
https://www.ncbi.nlm.nih.gov/pubmed/32253190
http://dx.doi.org/10.3399/bjgp20X709385
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