Impact of hospital admission upon patterns of primary care prescribing

Date of Approval
Application Number
16_180
Technical Summary

Prescribing is a key therapeutic intervention offered by doctors, with the majority occurring in primary care. Being admitted to hospital can result in considerable changes to a patient's usual medicines, resulting in medication errors and discrepancies. Little is known of the nature of these changes in UK clinical practice, such as which therapeutic areas are affected most and which patients are most likely to experience such changes.

Using data from 100,000 adult patients admitted to hospital in 2014, we will assess overall changes in all medicines immediately (<6 weeks) post-discharge. Secondary outcomes will include changes to specific therapeutic areas, potentially inappropriate prescribing, and further prescription changes by 6 months. Key exposures of interest will be reason for admission, urgency of admission, and length of hospitalisation. Multivariable regression will be used to model the association between outcomes and exposures, with adjustments made for age, gender, socioeconomic status, long-term morbidities, and GP surgery.

This work will provide a valuable insight on prescribing at the primary-secondary care interface. Understanding these issues will inform the improvement of medicines reconciliation processes tailored to relevant therapeutic areas, and help target interventions to those individuals most likely to benefit.

Health Outcomes to be Measured

Pre-admission and post discharge long- and short-term prescribing. Primary outcomes: change in total number of medicines following admission, and number of changes in medication following admission. Secondary outcomes: examining change in number of medicines and changes in medication within specific therapeutic areas. The presence of inappropriate prescriptions changes following hospitalisation

Collaborators

Rupert Payne - Chief Investigator - University of Bristol
Rachel Denholm - Collaborator - University of Bristol
Richard Morris - Collaborator - University of Bristol
Sarah Purdy - Collaborator - University of Bristol

Linkages

HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation