19 Critical review of the medication list when leaving hospital necessary, but not sufficient
When patients leave hospital, important decisions are made that determine their health and well-being. In order to achieve clear effects with regard to avoidable complications and premature readmissions, further measures are needed in addition to the critical review of medication together with the patients and their general practitioners.
Project description (completed research project)
21 hospitals in German-speaking Switzerland took part in the study. In order to enable hospital doctors to use the adapted checklists and discharge documents, a post-graduate training module was developed and implemented at twelve randomly selected hospitals. The other nine hospitals served as a comparison group. The effect of the training was tested over a period of 20 months by means of a controlled study. Data from the participating doctors and 600 patients about the time from discharge from hospital to re-admission, the number of visits to doctors and emergency departments, the number and type of drugs prescribed, patients’ quality of life and aspects of communication and processes were collected at discharge and after one, three and six months and compared with corresponding data from the control group.
During hospital stays, medication lists often become longer. Prescription of inadequate and/or too many different drugs has a negative impact on patients’ health, on hospitalisation rates and on health-related costs. This is why patients’ medication lists should be critically reviewed at discharge from hospital. Unnecessary or inadequate drugs should be discontinued in consensus with patients and their general practitioners.
The aim of the study was to show that systematically reviewing and optimising medication at discharge from hospital combined with a defined communication between hospitals and general practitioners leads to fewer re-admissions and better patient health. In addition, the feasibility of this approach and its impact on health-related costs were to be investigated.
The results show that the acceptance and feasibility of the approach used was positive for the majority of all participants. However, there were no significant effects of the approach in terms of hospital readmissions, deaths, emergency department visits or other doctor contacts. On average, patients in both groups were prescribed around ten discharge medications. In addition, six (intervention group) and seven percent (comparison group) of the patients had to be hospitalised again within 30 days. These readmission rates are two to three times lower than corresponding international values, which indicates a high quality of general discharge management at Swiss hospitals. To achieve more significant effects, more comprehensive interventions including patient coaching after hospital discharge would probably be needed.
Relevance / Application
The study provides a basis for optimised medication and communication at hospital discharge. The systematic review of the medication list is a low-cost and well-accepted measure which is effective in ambulatory care. However, at the hospital discharge transition, its effectiveness in terms of avoidable complications with premature readmission could not be proven. Further research must clarify how comprehensive and "mandatory" such measures must be so that they still can be implemented in routine practice and at the same time have a positive effect on the health of patients.
Improving inappropriate medication and information transfer at hospital discharge. A cluster-randomized controlled trial