Hospitalization Drug Regimen Changes in Geriatric Patients and Adherence to Modifications by General Practitioners in Primary Care

• Published in: The Journal of nutrition, health & aging Vol. 22; no. 3; pp. 328 - 334
• Main Authors: Rouch, Laure, Farbos, F., Cool, C., McCambridge, C., Hein, C., Elmalem, S., Rolland, Y., Vellas, B., Cestac, P.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.03.2018; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Aging; Ambulatory Care - statistics & numerical data; Attitude of Health Personnel; Clinical Protocols; Communication; Drug Prescriptions; Emergency Service, Hospital; Family physicians; Female; General Practitioners - statistics & numerical data; Geriatrics; Geriatrics/Gerontology; Hospitalization; Humans; Male; Medication Errors - statistics & numerical data; Medicine; Medicine & Public Health; Neurosciences; Nutrition; Patient compliance; Patient Discharge; Pharmacists; Primary care; Primary Care Medicine; Primary Health Care; Prospective Studies; Quality of Life Research; Treatment Adherence and Compliance - statistics & numerical data; hospitalization treatment modifications; adherence by general practitioners; Potentially inappropriate prescribing; communication; primary-secondary care interface
• ISSN: 1279-7707; 1760-4788
• DOI: 10.1007/s12603-017-0940-1

Objectives To evaluate the overall rate of adherence by general practitioners (GPs) to treatment modifications suggested at discharge from hospital and to assess the way communication between secondary and primary care could be improved. Design Observational prospective cohort study. Setting Patients hospitalized from the emergency department to the acute geriatric care unit of a university hospital. Participants 206 subjects with a mean age of 85 years. Measurements Changes in drug regimen undertaken during hospitalization were collected with the associated justifications. Adherence at one month by GPs to treatment modifications was assessed as well as modifications implemented in primary care with their rationale in case of non-adherence. Community pharmacists’ and GPs’ opinions about quality of communication and information transfer at hospital-general practice interface were investigated. Results 5.5 ± 2.8 drug regimen changes were done per patient during hospitalization. The rate of adherence by GPs to treatment modifications suggested at discharge from hospital was 83%. In most cases, non-adherence by GPs to treatment modifications done during hospitalization was due to dosage adjustments, symptoms resolution but also worsening of symptoms. The last of which was particularly true for psychotropic drugs. All GPs received their patients’ discharge letters but the timely dissemination still needs to be improved. Only 6.6% of community pharmacists were informed of treatment modifications done during their patients’ hospitalization. Conclusion Our findings showed a successful rate of adherence by GPs to treatment modifications suggested at discharge from hospital, due to the fact that optimization was done in a collaborative way between geriatricians and hospital pharmacists and that justifications for drug regimen changes were systematically provided in discharge letters. Communication processes at the interface between secondary and primary care, particularly with community pharmacists, must be strengthened to improve seamless care.