gms | German Medical Science

Context: The separation of health care in the primary and secondary sector is one factor accounting for a discontinuity in pharmacotherapy.

Aim of the study: To explore the influence of hospitalisation on the prescription of drugs in the primary care sector using prescription data of a major statutory health insurance company, with a particular focus on several drug classes, such as proton pump inhibitors (PPIs).

Material and method: We analysed drug prescriptions of patients in primary care who had been hospitalised during the first 3 months of 2005 (n=2,599 patients). The number and costs of all prescriptions of these patients 90 days before admission and after discharge, respectively, were compared.

Results: Overall costs increased after discharge by 25% and were most prominent for anti-thrombotic agents, analgetics and PPIs. The number of different active substances prescribed per patient raised by 10% from 5.3 to 5.8 per patient. Nearly all patients (2,538/2,599) were affected by changes in medication, and 50% had more than five changes, obviously initiated during hospitalisation. Of the substances prescribed to an individual before admission, 52% were cancelled after discharge, and 56% of all substances prescribed after discharge were novel prescriptions. Significantly more patients received a PPI after hospitalisation with a substantial increase especially in pantoprazol (RR for pantoprazol: 1.85; 95% CI: 1.58-2.17).

Conclusion: Hospitalisation is accompanied by changes in drug therapy for nearly every patient. Increases affect specialised therapeutics as well as on-patent drugs instead of less expensive alternatives. Outpatient prescription data may be a valid basis to monitor these drug changes and to evaluate, in due time, the effects of interventions to harmonise drug therapy between the primary and secondary sector.