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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)

  • The other day a research nurse from the DGH phoned the practice during a consultation to express “surprise” that I had not prescribed a statin for a frail very elderly lady with multimorbities including dementia. Staff and family were left in no doubt about what she thought of my careful consideration based on years of knowing the patient and her family. Didn’t give her name though!

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  • Similarly, discharge of 90 yr old from hospital to nursing home with ‘just in case’ meds written up but also prescribed dispersible atorvastatin...

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  • In 1997, every patient discharged from my ward went home with a TYPED discharge letter IN THEIR HAND.
    Then progress happened:
    Now, if becoming aware the patient has been home for some time already,I have to write to the hospital and request a discharge letter which then arrives a week later if you're lucky, in the meantime I am expected to guess the identity of pills needed for emergency prescription because run out,and only described by colour (and often inacurately too).
    This is diabolical negligent discharge!
    The only one worse is those institutions that have a policy of never sending a discharge summary and list of medicines as a policy. Yes they do exist, but I was surprised too, I thought they were obligatory, eventually.

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