gms | German Medical Science

In Germany, inpatient and outpatient patient-care are separated by relevant institutional, legal and traditional gaps. Anyway, the interface between hospital treatment and primary care is crucial to the quality of patient care. Not very much is known about continuity or discontinuity of care and its reasons at the hospital - GP-interface in German health care.

Here, we report of a qualitative approach. We recovered data about recommended and actual administered drug treatment from (1) hospital discharge letters, from (2) GPs' interviews and from (3) patient interviews from consecutive patients from the medical department of one hospital and created individual 'drug-careers' and charted reasons for continuity or discontinuity of medications.

There are 34 complete sets of data from 34 patients consisting of hospital discharge letter, GP-interview and patient interview each. Discontinuity of medication seems to be more the rule than the exception among these patients. Changes in medication can be found as well at the hospital-GP interface as at the GP-patient interface at similar frequencies, sometimes at different interfaces at once. Non-medical (e.g. economic) reasons for changes in medication are abundant, unintentional changes in medication (e.g. misunderstanding, forgetting and forgetfulness) are plenty.

Our qualitative data support the relevance of the hospital-GP-interface as a crucial point for the quality of individual drug treatment after hospital discharge. The nature of the data do not allow an estimation of the quantity of the phenomenon, but the reported reasons for .discontinuity of medications might be taken as a basis for further investigations of the problem or the development of interventions to decrease rates of discontinuity.