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GPs urged to be 'vigilant' as elderly 'harmed' by hospital prescribing

Researchers have urged GPs to be 'vigilant' as a new study revealed one in six older adults suffers preventable medication-related harm following hospital discharge.

The study, which focused on the East of England, found that within eight weeks of being discharged, three quarters of patients who experienced medication-related harm sought healthcare, and 78 patients per 1,000 were readmitted.

The researchers also estimated that such harm costs the NHS £396m every year, with more than 90% of this attributed to readmissions. However they said the majority of this cost - £243m - could be prevented.

In response, GP experts called for an improved discharge process and better coordination between hospitals and GP practices.

The research team, from the Brighton and Sussex Medical School, studied 1,280 older adults who were discharged from hospital and followed up with them for eight weeks, between September 2013 and November 2015.

A total of 1,116 patients were included in the final analysis, as 147 were lost through a lack of available GP records or could not be contacted. Seventeen patients died without a follow-up.

The paper, published in the British Journal of Clinical Pharmacology, found that 37% of participants experienced medication-related harm, with 556 events per 1,000 discharges.

Of these cases, 81% were 'serious', 52% were 'potentially preventable' and four resulted in death.

The most common events were gastrointestinal or neurological, with 25% and 18% of cases respectively, while the drugs associated with the highest risk were opiates, antibiotics and benzodiazepines.

Study author Dr Nikesh Parekh, a clinical research fellow in geriatrics at Brighton and Sussex Medical School, said: ‘It is vital that GPs remain vigilant to the additional vulnerability of patients in the post-discharge period and have robust processes in their surgery to reconcile medication lists at the earliest opportunity.’

He added: ‘Poor adherence to medicine contributed to one in four cases of medication harm, which stands to highlight the importance of shared medication-related decision making between prescribers and patients.’

But Professor Azeem Majeed, head of the primary care and public health department at Imperial College London said hospitals should be doing more to avoid patient harm.

He told Pulse: ‘A key step in reducing medication-related problems is to improve the discharge process for patients. This would include steps such as ensuring that discharge arrangements are discussed with patients, family members and carers; and that they are given a copy of the discharge summary.

'There should also be good coordination between the hospital, community health services, general practices, and the providers of social care services.'

'Hospitals should ensure that there is follow-up after discharge of patients at high risk of complications or readmission - either in person or by telephone - to ensure that the discharge arrangements are working well,' Professor Majeed added.

The findings come after a think tank report found that emergency readmissions within 30 days of leaving hospital have risen by a fifth in the last seven years, with potentially preventable cases increasing by over 40%.

Earlier this year health secretary Jeremy Hunt promised to make the NHS the 'safest healthcare system in the world' with a new national system linking GP prescribing with hospital admissions data, to see if a wrong prescription 'was the likely cause of a patient being admitted to hospital'.

So far the Government has published data related to gastro-intestinal bleeding. Although this does not yet single out individual  GP practices, the Department of Health and Social Care has said practice-level data will be published 'later in the year'.

 

Readers' comments (13)

  • Yet the recent consultation on supplying medications after hospital admissions only required trusts to give 7 days of meds, not 14, thus ensuring every complex blister pack multi-morbid patient with new meds has to have their meds updated urgently, rather than in a more structured way across the GP surgery working week.
    I highlighted this risk in the national consultation and it was obviously ignored.
    Why would you choose to add more urgent tasks to primary care as a matter of policy?

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  • 7 days isnt enough to get the letter to the GP let alone time to reconcile and weed out the dangerous prescribing done by hospitals Im afraid.

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  • does anyone else wonder why this is the GP's problem?

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  • It’s the GPs problem because we get blamed for everything, didn’t you know! The identified problem of post discharge medication problems isn’t really anything new and, in my experience, has been going on for years.
    With a workforce in the NHS that’s essentially understaffed and overworked it’s hardly surprising is it? With further budget cuts and cost efficiency savings likely the situation here will certainly worsen.
    Solution: don’t get ill or be admitted to hospital!

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  • Doctor McDoctor Face

    Isn't this in part a reflection of over medicalisation of normal ageing? Do we really need to give statins to the over 80s? Do we really need to aggressively treat hypertension in the over 80s? Is a low eGFR in the over 80s CKD or just normal old kidneys?

    I say this as the son of an 89 year old with severe dementia who was discharged from hospital after a fall with a bag bursting full of near pointless pills.

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  • So it’s the hospital are discharging them on the medication nd they come to harm.

    Shouldn’t that be a CQC thing,’patient safety thing, commissioning hing, NHS england thing etc etc not sure how that becomes the responsibility of general practice

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  • 10.51 that's exactly what I thought ...But then it swiftly struck me ... For every poor discharge , lack of medication, wrong medication, unfit to be at home etc etc there's only one person on who's doorstep this comes back to ... THE GP!... Forget getting the process right just let the GP clear up the mess

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  • It’s all about funding

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  • 1.09 exactly- if you have a busload of hungry people do you feed them at the fine dining restaurant or the all you can eat buffet

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  • AlanAlmond

    Everyone is chasing round like a slave to NICE guidelines sticking the elderly on multiple medications by protocol before swiftly getting them out the door of the hospital the minute their temperature seems stable. I appreciate that’s a gross generalisation and disservice to all those hard working hospital pre discharge teams but on a macro level that’s exactly what’s happening. The only people left practicing sensible pragmatic holistic medicine are GPs in general practice. But that takes time and resources, neither of what are currently available. The whole linking GP prescribing with hospital admissions scheme is approaching the problem from the wrong way round. It’s the massively resourced hospital specialists who pile on all the drugs, Someone goes into hospital and their case is picked over by no end of hospital staff, they have blood tests and scans and their treatment is tweaked and they are then rushed out as soon as is possible back into ‘the community’ frequently with a list of outstanding issues that need to be sorted out and very poor handover. Their care goes from a large team to a single individual who’s also got likly several thousand people already on his/her books and often grossly inadequate information...and the patient is given 7days worth of meds to tide them over. Jeremy Hunt thinks the medication errors are all the fault of primary care? This is a problem of inadequate resources and the inappropriate transfer of responsibility and risk away from the most highly resources part of the NHS onto the least. It saves the NHS cash, and of cause we pay for all that risk ourselves through sky rocketing indemnity fees. There’s so much wrong with the way the NHS is being organised there’s almost too much to describe.

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