title: Unintentional Discontinuation of Chronic Medications for Seniors in Nursing Homes: Evaluation of a National Medication Reconciliation Accreditation Requirement Using a Population-Based Cohort Study.
abstract: Transitions of care leave patients vulnerable to the unintentional discontinuation of medications with proven efficacy for treating chronic diseases. Older adults residing in nursing homes may be especially susceptible to this preventable adverse event. The effect of large-scale policy changes on improving this practice is unknown.The objective of this study was to analyze the effect of a national medication reconciliation accreditation requirement for nursing homes on rates of unintentional medication discontinuation after hospital discharge.It was a population-based retrospective cohort study that used linked administrative records between 2003 and 2012 of all hospitalizations in Ontario, Canada. We identified nursing home residents aged ≥66 years who had continuous use of ≥1 of the 3 selected medications for chronic disease: levothyroxine, HMG-CoA reductase inhibitors (statins), and proton pump inhibitors (PPIs).In 2008 medication reconciliation became a required practice for accreditation of Canadian nursing homes.The main outcome measures included the proportion of patients who restarted the medication of interest after hospital discharge at 7 days. We also performed a time series analysis to examine the impact of the accreditation requirement on rates of unintentional medication discontinuation.The study included 113,088 adults aged ≥66 years who were nursing home residents, had an acute hospitalization, and were discharged alive to the same nursing home. Overall rates of discontinuation at 7-days after hospital discharge were highest in 2003-2004 for all nursing homes: 23.9% for thyroxine, 26.4% for statins, and 23.9% for PPIs. In most of the cases, these overall rates decreased annually and were lowest in 2011-2012: 4.0% for thyroxine, 10.6% for statins, and 8.3% for PPIs. The time series analysis found that nursing home accreditation did not significantly lower medication discontinuation rates for any of the 3 drug groups.From 2003 to 2012, there were marked improvements in rates of unintentional medication discontinuation among hospitalized older adults who were admitted from and discharged to nursing homes. This change was not directly associated with the new medication reconciliation accreditation requirement, but the overall improvements observed may have been reflective of multiple processes and not 1 individual intervention.
authors.affiliation: From the Department of Medicine (NMS, EE, CMB), University of Toronto; Institute for Clinical and Evaluative Sciences (HDF, ASB, S Bronskill, MMM, PR, DRU, CFW, CMB); Keenan Research Centre (ASB, MMM), Li Ka Shing Knowledge Institute, St Michael's Hospital; Institute of Health Policy, Management and Evaluation (ASB, S Bronskill, EE, PR, DRU, CMB); Lawrence S. Bloomberg Faculty of Nursing (ASB), University of Toronto; Health Quality Ontario (S Brener); Department of Pharmacy (OF), University Health Network; Leslie Dan Faculty of Pharmacy (OF, MMM), University of Toronto; Division of General Internal Medicine (DL, CMB), Mount Sinai Hospital; Women's College Research Institute (PR), Women's College Hospital; and Department of Surgery (DRU), University of Toronto, Toronto, Canada.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Stall
authors.forename: Hadas D
authors.initials: HD
authors.lastname: Fischer
authors.forename: C Fangyun
authors.initials: CF
authors.lastname: Wu
authors.forename: Arlene S
authors.initials: AS
authors.lastname: Bierman
authors.forename: Stacey
authors.initials: S
authors.lastname: Brener
authors.forename: Susan
authors.initials: S
authors.lastname: Bronskill
authors.forename: Edward
authors.initials: E
authors.lastname: Etchells
authors.forename: Olavo
authors.initials: O
authors.lastname: Fernandes
authors.forename: Davina
authors.initials: D
authors.lastname: Lau
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
authors.forename: Paula
authors.initials: P
authors.lastname: Rochon
authors.forename: David R
authors.initials: DR
authors.lastname: Urbach
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
mesh_terms: D000068:Accreditation / Q000592:standards; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D059065:Medication Reconciliation / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012189:Retrospective Studies