Examining the Influence of Emergency Hospital Admissions and health management on Primary Care Prescription Patterns: A Retrospective Cohort Analysis of Electronic Records
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Keywords
Hospital admission; Emergency department; Inappropriate prescribing; Polypharmacy; Primary care.
Abstract
Understanding the impact of hospitalization on prescribing practices clinical settings remains limited.
Aim: This study aims to explore whether emergency hospital admissions contribute to increases in polypharmacy and potentially inappropriate prescriptions (PIPs).
Design and Setting: A retrospective cohort analysis conducted in primary and secondary care facilities .
Method: Changes in prescription numbers and incidence of PIPs were assessed following emergency hospital admissions , at admission, 4 weeks post-discharge, and 6 months post-discharge among 37,761 adult patients. Regression models were employed to examine shifts in prescribing patterns post-admission.
Results: Among 32,657 surviving emergency attendees after 6 months, the mean number of prescriptions increased from 4.4 (standard deviation [SD] = 4.6) before admission to 4.7 (SD = 4.7; P<0.001) 4 weeks post-discharge. Minor increases (<0.5) in 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 incidence of PIPs rose post-hospitalization, with 4.0% of patients having ≥1 PIP before admission, increasing to 8.0% 4 weeks post-discharge. Specialty-wise, increases in PIP occurrence ranged from 2.1% in obstetrics and gynecology to 8.0% in cardiology. Patients were prescribed fewer medicines on average at 6 months post-discharge compared to 4 weeks (mean = 4.1; SD = 4.6; P<0.001), with PIP incidence decreasing to 5.4% (n = 1751) of patients.
Conclusion: Notions suggesting that hospitalization consistently leads to polypharmacy escalation are unfounded. Post-hospitalization increases in prescribing appear to reflect appropriate clinical responses to acute illness, whereas decreases are more likely among multimorbid patients, reflecting a focus on deprescribing and medicines optimization. However, concerns persist regarding the rise in PIPs.
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