Medication use and potentially high‐risk prescribing in older patients hospitalized for diabetes: a missed opportunity to improve care?
Abstract Aims To examine the appropriateness of medicine use and potentially high‐risk prescribing before and after hospitalization for diabetes. Methods A retrospective cohort study of patients hospitalized for diabetes was conducted using administrative data from the Australian Government Department of Veterans’ Affairs for the period between 1 January 2012 and 31 December 2012. The appropriateness of medicine use and potentially high‐risk prescribing, including hyper‐polypharmacy and associated treatment conflicts, were examined for the 120‐day periods before and after hospitalization. Results A total of 876 patients were hospitalized for a diabetes‐related complication. Of these, 25% were not dispensed an antidiabetic medicine 4 months before hospitalization and 25% had not had their HbA 1c levels measured in the preceding 6 months. The use of antidiabetic medicines increased to 85% after hospitalization, with a 25.6% relative increase (95% CI 10.9–42.1) in the proportion of those dispensed insulin. The prevalence of high‐risk prescribing before hospital admission was high; 70% had > 10 medicines dispensed, a third had at least one treatment conflict and half were dispensed a potentially inappropriate medicine. The use of long‐acting sulphonylureas and corticosteroids had relative decreases of 46.0% (95% CI 17.0–64.9) and 29.9% (95% CI 8.8–46.0), respectively. Few changes in other high‐risk prescribing patterns were observed after discharge. Conclusions This study has identified poor medication‐related care and, in particular, high‐risk‐prescribing in people subsequently hospitalized for diabetes. While diabetes medicine use improved after hospitalization, there was little change in potentially inappropriate medicine use, which suggests that an opportunity to improve medication use in this older vulnerable population has been missed.
What's new? This nationwide prospective cohort study describes the real‐life prescribing of guideline‐recommended therapies, the appropriateness of medicine use and the potentially high‐risk prescribing associated with comorbid conditions in older patients before and after a diabetes hospitalization in Australia.Sub‐optimum use of diabetic therapy and high‐risk prescribing among older patients with diabetes, including 70% with hyper‐polypharmacy, a third having at least one treatment conflict and almost 50% being dispensed a potentially inappropriate medicine, was observed before hospitalization.After hospitalization, the use of diabetic medicines improved, but little change in high‐risk prescribing was observed. This highlights where medicine‐related care for older patients with diabetes needs to be improved.
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