Department of Health Policy, Management, and Evaluation, Keenan Research Centre in Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, Ontario, Canada.
JAMA. 2011 Aug 24;306(8):840-7. doi: 10.1001/jama.2011.1206.
Patients discharged from acute care hospitals may be at risk for unintentional discontinuation of medications prescribed for chronic diseases. The intensive care unit (ICU) may pose an even greater risk because of the focus on acute events and the presence of multiple transitions in care.
To evaluate rates of potentially unintentional discontinuation of medications following hospital or ICU admission.
DESIGN, SETTING, AND PATIENTS: A population-based cohort study using administrative records from 1997 to 2009 of all hospitalizations and outpatient prescriptions in Ontario, Canada; it included 396,380 patients aged 66 years or older with continuous use of at least 1 of 5 evidence-based medication groups prescribed for long-term use: (1) statins, (2) antiplatelet/anticoagulant agents, (3) levothyroxine, (4) respiratory inhalers, and (5) gastric acid-suppressing drugs. Rates of medication discontinuation were compared across 3 groups: patients admitted to the ICU, patients hospitalized without ICU admission, and nonhospitalized patients (controls). Odds ratios (ORs) were calculated and adjusted for patient demographics, clinical factors, and health services use.
The primary outcome was failure to renew the prescription within 90 days after hospital discharge.
Patients admitted to the hospital (n = 187,912) were more likely to experience potentially unintentional discontinuation of medications than controls (n = 208,468) across all medication groups examined. The adjusted ORs (AORs) ranged from 1.18 (95% CI, 1.14-1.23) for discontinuing levothyroxine in 12.3% of hospitalized patients (n = 6831) vs 11.0% of controls (n = 7114) to an AOR of 1.86 (95% CI, 1.77-1.97) for discontinuing antiplatelet/anticoagulant agents in 19.4% of hospitalized patients (n = 5564) vs 11.8% of controls (n = 2535). With ICU exposure, the AORs ranged from 1.48 (95% CI, 1.39-1.57) for discontinuing statins in 14.6% of ICU patients (n = 1484) to an AOR of 2.31 (95% CI, 2.07-2.57) for discontinuing antiplatelet/anticoagulant agents in 22.8% of ICU patients (n = 522) vs the control group. Admission to an ICU was associated with an additional risk of medication discontinuation in 4 of 5 medication groups vs hospitalizations without an ICU admission. One-year follow-up of patients who discontinued medications showed an elevated AOR for the secondary composite outcome of death, emergency department visit, or emergent hospitalization of 1.07 (95% CI, 1.03-1.11) in the statins group and of 1.10 (95% CI, 1.03-1.16) in the antiplatelet/anticoagulant agents group.
Patients prescribed medications for chronic diseases were at risk for potentially unintentional discontinuation after hospital admission. Admission to the ICU was generally associated with an even higher risk of medication discontinuation.
从急性护理医院出院的患者可能存在因意外而停止使用处方治疗慢性病的药物的风险。重症监护病房（ICU）由于专注于急性事件以及存在多种护理交接，可能存在更大的风险。
评估患者住院或入住 ICU 后药物意外停用的发生率。
设计、环境和患者：这是一项基于人群的队列研究，使用了加拿大安大略省 1997 年至 2009 年的所有住院和门诊处方的行政记录；纳入了 396380 名年龄在 66 岁或以上、持续使用至少 5 种证据支持的药物组之一的患者：（1）他汀类药物，（2）抗血小板/抗凝药物，（3）左甲状腺素，（4）呼吸吸入剂，和（5）胃酸抑制药物。比较了三组患者的停药率：入住 ICU 的患者、无 ICU 住院的患者和非住院患者（对照组）。计算比值比（ORs）并进行了患者人口统计学、临床因素和卫生服务利用的调整。
主要结局是出院后 90 天内未能续开处方。
与对照组（n=208468）相比，所有研究药物组中，住院患者（n=187912）更有可能出现药物意外停用（n=187912）。调整后的比值比（AORs）范围从 1.18（95%可信区间，1.14-1.23）（12.3%的住院患者[n=6831]停止使用左甲状腺素，11.0%的对照组[n=7114]）到 1.86（95%可信区间，1.77-1.97）（19.4%的住院患者[n=5564]停止使用抗血小板/抗凝药物，11.8%的对照组[n=2535]）。在 ICU 暴露的情况下，AORs 范围从 1.48（95%可信区间，1.39-1.57）（14.6%的 ICU 患者[n=1484]停止使用他汀类药物）到 2.31（95%可信区间，2.07-2.57）（22.8%的 ICU 患者[n=522]停止使用抗血小板/抗凝药物）与对照组相比。与非 ICU 住院相比，入住 ICU 与 5 种药物中的 4 种药物的停药风险增加相关。停止使用药物的患者在一年的随访中，他汀类药物组的次要复合结局（死亡、急诊就诊或紧急住院）的比值比为 1.07（95%可信区间，1.03-1.11），抗血小板/抗凝药物组为 1.10（95%可信区间，1.03-1.16）。
因慢性病而开具药物治疗的患者在住院后可能面临药物意外停用的风险。入住 ICU 通常与更高的药物停用风险相关。
