Influence of hospitalisation on the prescription of drugs in the primary care sector

Abstract

To explore the influence of hospitalisation on the prescription of drugs in the primary care sector, particularly on HMG CoA reductase inhibitors (statins) and proton pump inhibitors (PPIs). Methods: Analysis of outpatient drug prescriptions of members of a statutory health insurance that were inpatient in the I. quarter 2004. Prescriptions done within three months before admission or after discharge were analysed. Drugs were coded with central pharmaceutical number, active substances and costs were linked with the ATC-Code and the pharmacy price schedule, respectively. Results: 2,426 patients received drugs before and after hospitalisation. After discharge the mean number of prescription per patient remained unchanged, while the number of different active substances decreased (-4%). Still overall costs increased after discharge due to higher costs per prescription (+17%). Changes in medication affected nearly every patient, and more than 50% of all substances prescribed to an individual before admission or after discharge were cancelled or newly started, respectively. In both therapeutic subgroups analysed in detail, PPIs and statins, significant increases in the number of patients under therapy occurred (+27% and +16%, respectively). The increase in PPI-medication was due to a 58% rise in the number of patients getting pantoprazole, while that for statins comprised all relevant agents with a slight preference of the on-patent agents atorvastatin and fluvastatin. Conclusion: Hospitalisation exerts a marked influence on drug therapy in ambulatory care. Thereby a change towards on-patent drugs occur despite less pricey alternatives. Out-patient prescription data are suitable to describe these changes.