Effects Are not Clear
The authors studied the two interfaces when a patient passes from one care sector into another with regard to their implications for medication, and they attempted to structure this (1). While the title implies a study of an intervention after discharge, what was actually studied were several interventions in an inpatient setting, whose respective proportion in the overall result is not easy to identify. The effect of involving a clinical pharmacist, for example, is not clear. It is surprising that the authors did not think of the information event for regional general practitioners as an intervention. The categorization of the medication changes deserves criticism. Category A creates the impression that recommendations from the inpatient setting are binding and always well-founded. From a family medical perspective, we take issue with this statement. Prescribing long-term and radical medication must be based on effectiveness, tolerability, and considerations of potential interactions, in addition to the indication. In addition to patients’ perspectives—not the subject of the article—there are considerations of cost effectiveness, which are determined in the outpatient setting by the medication guidelines of the G-BA (Gemeinsamer Bundesausschuss, Federal Joint Committee), which do not apply in the inpatient setting. For a meaningful intervention, a medication check based on the guideline on polypharmacy might be useful.
Inpatient recommendations are based on experiences gained within a very small segment of the patient’s journey, in the concrete scenario on a mean of 7 days. The general practitioner will have better knowledge about the patient’s everyday life and resources, on the basis of a regular, longer and more comprehensive relationship. All this can be the reason for the discontinuation of a medication that is recommended and indicated in the discharge summary. The article makes no mention of these factors.
Dr. med. Kai-Florian Mehrländer, Barmstedt
Dr. med. Ilja Karl, Kalbe/Milde
Conflict of interest statement
The authors declare that no conflict of interest exists.
|1.||Greißing C, Buchal P, Kabitz HJ, et al.: Medication and treatment adherence following hospital discharge—a study of an intervention aimed at reducing risk associated with medication change. Dtsch Arztebl Int 2016; 113: 749–56 VOLLTEXT|