Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol.
Bristol Medical School, University of Bristol, Bristol.
Br J Gen Pract. 2020 May 28;70(695):e399-e405. doi: 10.3399/bjgp20X709385. Print 2020 Jun.
Little is known about the impact of hospitalisation on prescribing in UK clinical practice.
To investigate whether an emergency hospital admission drives increases in polypharmacy and potentially inappropriate prescriptions (PIPs).
A retrospective cohort analysis set in primary and secondary care in England.
Changes in number of prescriptions and PIPs following an emergency hospital admission in 2014 (at admission and 4 weeks post-discharge), and 6 months post-discharge were calculated among 37 761 adult patients. Regression models were used to investigate changes in prescribing following an admission.
Emergency attendees surviving 6 months ( = 32 657) had a mean of 4.4 (standard deviation [SD] = 4.6) prescriptions before admission, and a mean of 4.7 (SD = 4.7; <0.001) 4 weeks after discharge. Small increases (<0.5) in the number of prescriptions at 4 weeks were observed across most hospital specialties, except for surgery (-0.02; SD = 0.65) and cardiology (2.1; SD = 2.6). The amount of PIPs increased after hospitalisation; 4.0% of patients had ≥1 PIP immediately before pre-admission, increasing to 8.0% 4 weeks post-discharge. Across hospital specialties, increases in the proportion of patients with a PIP ranged from 2.1% in obstetrics and gynaecology to 8.0% in cardiology. Patients were, on average, prescribed fewer medicines at 6 months compared with 4 weeks post-discharge (mean = 4.1; SD = 4.6; <0.001). PIPs decreased to 5.4% ( = 1751) of patients.
Perceptions that hospitalisation is a consistent factor driving rises in polypharmacy are unfounded. Increases in prescribing post-hospitalisation reflect appropriate clinical response to acute illness, whereas decreases are more likely in patients who are multimorbid, reflecting a focus on deprescribing and medicines optimisation in these individuals. Increases in PIPs remain a concern.
关于住院对英国临床实践中处方的影响知之甚少。
研究急诊入院是否会导致多种药物治疗和潜在不适当处方（PIP）的增加。
在英格兰的初级和二级保健中进行回顾性队列分析。
在 2014 年（入院时和出院后 4 周）和出院后 6 个月，对 37761 名成年患者的急诊入院后处方数量和 PIP 的变化进行了计算。使用回归模型来研究入院后处方的变化。
存活至 6 个月的急诊患者（n=32657）入院前平均处方 4.4 种（标准差[SD] = 4.6），出院后 4 周平均处方 4.7 种（SD = 4.7；<0.001）。除了外科（-0.02；SD = 0.65）和心脏病学（2.1；SD = 2.6）外，大多数医院科室在 4 周时处方数量略有增加（<0.5）。住院后 PIP 的数量增加；4.0%的患者在入院前即有≥1 个 PIP，出院后 4 周时增加到 8.0%。在各个医院科室中，患有 PIP 的患者比例从妇产科的 2.1%增加到心脏病学的 8.0%。与出院后 4 周相比，患者在 6 个月时平均服用的药物更少（平均=4.1；SD=4.6；<0.001）。PIP 减少至 5.4%（n=1751）的患者。
认为住院是导致多种药物治疗增加的一致因素的观点是没有根据的。住院后处方的增加反映了对急性疾病的适当临床反应，而在多疾病患者中，处方减少的可能性更大，这反映了在这些患者中专注于减少用药和优化药物治疗。PIP 的增加仍然令人担忧。
