Frequency and predictors of drug therapy interruptions after hospital discharge under physician drug budgets in Germany.
OBJECTIVE
We sought to study how frequently prescription drug therapy at hospital discharge was discontinued or changed by general practitioners under physician drug budgets in Germany and explore reasons and predictors for such discontinuations.


METHODS
This cohort study was part of a larger project on clinical outcomes of acute hospital care in patients with 5 groups of medical diagnoses, including conditions of the heart, lung and brain, gastroduodenal ulcer disease and diabetes. Patients entered the study cohort at hospital admission and were followed throughout their stay until they had their first encounter with a primary care physician responsible for follow-up treatment after hospital discharge. Nurse practitioners and physicians assessed patient characteristics at admission and discharge. A 1-page questionnaire on continuity of care, including drug therapy, was provided to primary care physicians at the first patient encounter. The primary study endpoint was discontinuation of drug therapy by the primary care physician. Data were analyzed by multivariate logistic regression.


RESULTS
A total of 3,267 patients in 22 primary care hospitals were eligible for the study. Standardized questionnaires on continuation of drug therapy were returned by 890 patients (27%); 846 patients (95%) used prescription drugs at discharge. Of those, drug therapy was interrupted in 122 (14%). Reasons for discontinuations included excessive costs of drugs in 66 patients (54%), excessive number of drugs prescribed (32, 26%) and differences in judgment on the clinical appropriateness of a drug (23, 19%). In a multivariate logistic regression, gastroduodenal ulcer disease was a significant predictor for discontinuation (OR = 3.1; 95% CI 1.5 - 6.5). Discontinuation tended to be more likely in older patients (69 - 76 years vs. < or = 58: OR = 2.0; 1.0 - 3.9) but slightly less likely in male patients (OR = 0.7; 0.4 - 1.1).


CONCLUSIONS
Discontinuation of drug therapy after hospital discharge is common. The high costs of prescription drugs were the most common reason. Elderly patients seem to be particularly affected.
Taxis
K
K
Pharmazeutische Biologie, Pharmazeutisches Institut, Universität Tübingen, Germany. katja.taxis@uni-tuebingen.de
Schneeweiss
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004358:Drug Therapy / Q000191:economics*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011306:Prescription Fees; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000706:statistics & numerical data*