What happens to long-term medication when general practice patients are referred to hospital?

Objective: The aim of the study was to determine changes in drug treatment of general practitioners' patients on hospital admission and after discharge, and to identify communication problems.

Methods: During 15 months all chronically ill patients of one general practice who were referred to hospital (n = 130) were followed-up prospectively with regard to long-term medication in general practice, drugs recommended in hospital for continuing treatment and medication after discharge from hospital.

Results: Before hospital admission the 130 patients were receiving 420 medicines long-term (14% generic drugs). The hospital doctors cancelled 28% (116/420) of the drugs, 6% were replaced by other drugs, 11% by another brand name (identical chemical substance but different producer) and 31 generics were replaced by brand name drugs. Hospitals exhibited specific drug profiles (e.g., total replacement of some generics by brand name drugs; and exclusive administration of a certain preparation regardless of the general practitioner's prescription). After discharge from hospital, the general practitioner continued 329 of the 496 drugs (66.1%) recommended by hospital, 105 (21%) drugs were replaced by other drugs (49 of them by generics) and 62 drugs (13%) were cancelled. The general practitioner received detailed information about drug change in only five of the 130 hospital discharge letters.

Conclusion: 50% turnover in drug use between general practice and hospital and some of the patterns of drug change in hospital may be unnecessary. They may also complicate the difficult task of the general practitioner of maintaining a patient's drug regimen.