Studies of Outcomes, Risks, Costs, and Benefits

Association of ICU or Hospital Admission With Unintentional Discontinuation of Medications for Chronic Diseases

Bell CM, Brener SS, Gunraj N, et al (Univ of Toronto, Ontario, Canada; Inst for Clinical Evaluative Sciences, Toronto, Ontario, Canada) JAMA 306:840-847, 2011^§

Abstract

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.

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