WHAT MEDICATIONS ARE OUR PATIENTS

TAKING AT HOME?

  

MEDICATION DISCREPANCIES AFTER DISCHARGE FROM ARURAL DISTRICT HOSPITAL

THE SCENARIO

THE STUDY

• HETI RURAL RESEARCH CAPACITY BUILDING PROGRAM

• The aim of this study was to investigate the research question: Are patients discharged from an Australian rural hospital taking their medication as documented in their hospital discharge summary within one month of discharge? 

METHOD

• This study used a cross sectional survey design which involved using semi-structured telephone interviews of patients discharged from the medical teams of a 162 bed general NSW based rural hospital. 

• The semi-structured interview questions were designed to ascertain whether there were any discrepancies between medications documented on discharge from hospital and those reported by the patient within a month of discharge. 

PARTICIPANTS

• 96 initially enrolled

• 71 (74%) finally interviewed: 

• 14  could not contact• 7 in another care facility• 4 withdrew consent on telephone contact

• 66 finally analysed

• 5  no completed discharge summary

TELEPHONE QUESTIONNAIRE 

• What medication are you taking now

• Prompt sheet

• Compared to medication documented on discharge summary

DISCREPANCIES DOCUMENTED & CLASSIFIED

• Medical officer initiated

• Patient led

• Continuing previous regime• Medication not considered significant – script not filled

• Medication too expensive• Medication caused side effects• Other as specified by patient

CHARACTERISTICS Mean (range)

Age in years 75 (42-92)Length of stay days 5.5 (2-26)Number of medications on discharge summary 8.8 (2-19)Median number of medication on discharge summary 9 ( 6-10.8) *Number of medication changes during admission from discharge summary

3 (0-10)

N (%) Gender

Male 31 (47%)Female 35 (53%)

Principal Diagnosis †Diseases and disorders of the respiratory system 10 (15.2%)Diseases and disorders of the circulatory system 20 (30.3%)Diseases and disorders of the musculoskeletal system and connective tissue

7 (10.6%)

Infectious and parasitic diseases 11 (16.7%)

Appointment with Medical officer post discharge 55 (83%)Within 7 days (46 with GP 3 with specialist) 49 (74%)Longer than 7 days 6 (9%)No medical officer appointment between discharge and follow up phone call (>13 days)

11 (17%)

Discharge information given at discharge – as reported by participant (%)

Yes 25 (38%)No 29 (44%)Don’t remember 12 (18%)

Pharmacy Medication list given - as reported by participant

Yes 45 (68%)No or don’t remember 21 (32%)

Medication manager Self 50 (77%)Carer 12 (18%)Both 4 (6%)

Adherence Measure¶ Low 13 (20%)Medium 14 (21%)High 39 (59%)

Dosage Administration Aid usedYes 20 (33%)No 46 (66%)

RESULTS – NUMBER OF DISCREPANCIES PER PARTICIPANT

NUMBER OF DISCREPANCIES PER

PARTICIPANTNUMBER OF

PARTICIPANTS

TYPE OF DISCREPANCIES

TOTAL NUMBER OF

DISCREPANCIESADDITIONS OMISSIONS

CHANGED DRUGSAME CLASS

CHANGED DOSE

0 5 0 0 0 0 0

1 8 4 3 0 1 8

2 19 18 11 4 5 38

3 10 22 4 1 3 30

4 6 16 8 0 0 24

5 6 17 9 2 2 30

6 5 23 4 1 2 30

7 3 18 0 1 2 21

> 8 4 30 12 1 4 47

OR TO PUT IT A DIFFERENT WAY….

NUMBER OF DISCREPANCIES PER

PARTICIPANTNUMBER OF

PARTICIPANTS

TYPE OF DISCREPANCIES

TOTAL NUMBER OF

DISCREPANCIESADDITION

SOMISSION

S

CHANGED DRUGSAME CLASS

CHANGED DOSE

0 5 0 0 0 0 0

1 or more 61 148 51 10 19 228

3 or more 33 124 38 5 13 180

5 or more 18 88 26 5 10 129

8 or more 4 30 13 1 4 48

N (%)TOTAL NUMBER OF DISCREPANCIES 228 (100%)

ADDITIONS – COMPARED TO DISCHARGE SUMMARY 148 (65%)

ADDITIONS - EXCLUDING OTC AND CAM 82 (36%)

OMISSIONS – COMPARED TO DISCHARGE SUMMARY 51 (22.4%)

OMISSIONS – EXCLUDING OTC AND CAM 45 (19.7%)

CHANGED DRUG – SAME PHARMACOLOGICAL CLASS - 10 (4.4%)

CHANGED DOSE - COMPARED TO DISCHARGE SUMMARY 19 (8.3%)

TYPE OF DISCREPANCIES

ADDED MEDICATIONDRUG GROUP EXAMPLE OF MEDICATIONS

Analgesics Oxycodone, paracetamol/codeine, tramadol, gabapentin  Blood and electrolytes

Warfarin x 2, Potassium chloride, 

Cardivascular amiodarone,  atorvastatin,  digoxin,  diltiazem,  frusemide, glyceryl  trinitrate  patch,  spironolactone,  telmisartan  + hydrochlorothiazide

Endocrine risedronateGastrointestinal esomeprazole, pantoprazole, sucralfateGenitourinary oxybutyninImmunomodulators prednisoloneMuscular skeletal allopurinolPsychotropic diazepam, mirtazepine, nitrazepam, risperidoneRespiratory salbutamol,  tiotropium,  Seretide®,    Symbicort®, 

(numerous)

OMITTED MEDICATIONDRUG GROUP MEDICATIONSANALGESICS Gabapentin, oxycodoneBLOOD AND ELECTROLYTES Aspirin x 4, potassium chloride,CARDIVASCULAR diltiazem,  irbesartan  +  hydrochlorothiazide, 

spironolactone, 

EAR NOSE THROAT betahistineGASTROINTESTINAL esomeprazole, pantoprazole, prochlorperazine, 

metoclopramide

GENITOURINARY Prazosin tamsulosinRESPIRATORY Bromhexine, tiotropium, ‘Seretide’, ‘Symbicort’

OTC AND CAM calcium,  cyanocobalamin,  magnesium, thiamine, vitamin D

REASON N (%)MEDICAL OFFICER THERAPEUTIC CHANGE POST DISCHARGE - NUMBER OF INTENTIONAL DISCREPANCIES (%)

73 (32%)

PARTICIPANT LED CHANGE – TOTAL 155 (68%)

PARTICIPANT CONTINUING PREVIOUS REGIME 129 (57%)

PRESCRIBED MEDICATION THOUGHT NOT NECESSARY – DIDN’T FILL SCRIPT OR BUY MEDICINE

20 (9%)

PARTICIPANT DIDN’T KNOW OF CHANGES/FORGOT 4 (2%)

MEDICATION TOO EXPENSIVE 1 (0.4%)

MEDICATION CAUSED SIDE EFFECT – CEASED 1 (0.4%)

REASON FOR DISCREPANCY

CONCLUSIONS

• In conclusion, this study has demonstrated that within a month after discharge from an Australian rural hospital the participants are not taking their medication as documented in their hospital discharge summary. 

RECOMMENDATION

• This study has demonstrated a problem with the continuity of care in terms of medication discrepancy for patients discharged from our rural hospital.

• Medication reconciliation at all points of the health care cycle

• MMP• Improved communication of changes• eHealth???