title: Medication Discontinuation in Patients After Discharge From a Psychiatric Hospital.
abstract: BACKGROUND
  Patients discharged from psychiatric hospitals may be at risk for intentional or unintentional discontinuation of their medication.
  
  
  OBJECTIVE
  To describe and assess the discontinuation of, and changes to, psychiatric and/or somatic medication in patients after discharge from psychiatric hospitals.
  
  
  METHODS
  A retrospective follow-up study was conducted in patients discharged from 4 psychiatric hospitals in The Netherlands between 2006 and 2009. Patients' medication use during the last 2 days of hospitalization was compared with medication dispensed during the 3 months following discharge. Changes in psychiatric and somatic medication were investigated and defined as medication discontinuation, start, or switch. Patients were classified as continuing users, when there were no changes to the medication after discharge. Relative risks with 95% confidence intervals to measure differences in discontinuation were estimated using Cox regression analysis.
  
  
  RESULTS
  This study included 1324 patients, 69.8% of whom discontinued medication, and 9.7% switched one or more medications. Nearly half (47.4%) of all patients started a medication other than that dispensed during the last 2 days of hospitalization, and 13.7% of all patients experienced no changes to their medication regimen. Approximately 40% of the patients discontinued one or more medications for chronic conditions. From these, 68% discontinued psychiatric medications and 49.4% discontinued somatic medications. A quarter (25.2%) of the 644 patients discontinued using antipsychotics. More than a quarter (28.4%) of the 292 patients using medications for cardiovascular problems discontinued. Patients using as-needed medication prior to discharge were more likely to discontinue their medication (relative risk = 1.85; 95% confidence interval = 1.55-2.20).
  
  
  CONCLUSIONS
  Discharge from a psychiatric hospital led to medication discontinuation in approximately 70% of all patients. Approximately 40% of the patients discontinued medications for chronic conditions. Discontinuation of somatic medication was more frequent than discontinuation of psychiatric medication, and risk of discontinuation was lower for patients with depressive and anxiety disorders. Although medication discontinuation can be deliberate it is alarming that a quarter of our patients using antipsychotics and cardiovascular medications discontinued their use, both of which are meant for chronic conditions.
authors.affiliation: Utrecht University, Utrecht, The Netherlands Brocacef Ziekenhuisfarmacie, Den Dolder, The Netherlands Diakonessenhuis, Utrecht, The Netherlands.
authors.forename: Heshu
authors.initials: H
authors.lastname: Abdullah-Koolmees
authors.affiliation: Utrecht University, Utrecht, The Netherlands University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Helga
authors.initials: H
authors.lastname: Gardarsdottir
authors.affiliation: Utrecht University, Utrecht, The Netherlands.
authors.forename: Dilek
authors.initials: D
authors.lastname: Yazir
authors.affiliation: Brocacef Ziekenhuisfarmacie, Den Dolder, The Netherlands.
authors.forename: Lennart J
authors.initials: LJ
authors.lastname: Stoker
authors.affiliation: Altrecht Institute for Mental Health Care, Utrecht, The Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: Vuyk
authors.affiliation: Utrecht University, Utrecht, The Netherlands University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Toine C G
authors.initials: TC
authors.lastname: Egberts
authors.affiliation: Utrecht University, Utrecht, The Netherlands University Medical Center Utrecht, Utrecht, The Netherlands Altrecht Institute for Mental Health Care, Utrecht, The Netherlands e.r.heerdink@uu.nl.
authors.forename: Eibert R
authors.initials: ER
authors.lastname: Heerdink
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D003266:Continuity of Patient Care; D005500:Follow-Up Studies; D006778:Hospitals, Psychiatric; D006801:Humans; D055118:Medication Adherence; D010351:Patient Discharge; D012189:Retrospective Studies; D012306:Risk
chemical_list: D014150:Antipsychotic Agents; D002317:Cardiovascular Agents
keywords: change of setting; changes; continuation of care; discharge; discontinuation; medication; psychiatric hospital; psychiatry