Statin discontinuation and new antipsychotic use after an acute hospital stay vary by hospital.

Abstract

INTRODUCTION:Patients are at risk for medication problems after hospital admissions, particularly those with critical illness. Medication problems include continuation of acute medications and discontinuation of chronic medications after discharge. Little is known across a national integrated health care system about the extent of these two medication problems. OBJECTIVE:To examine the extent of statin medication discontinuation and new antipsychotic medication use after hospital discharge. DESIGN:Retrospective cohort study. SETTING:Veterans Affairs healthcare system. PARTICIPANTS:Veterans with an inpatient hospitalization from January 1, 2014-December 31, 2016, survived at least 180 days post-discharge, and received at least one medication through the VA outpatient pharmacy within one year around admission were included. Hospitalizations were grouped into: 1) direct admission to the intensive care unit (ICU) and a diagnosis of sepsis, 2) direct admission to the ICU without sepsis diagnosis, and 3) no ICU stay during the hospitalization. MAIN OUTCOME MEASURES:Statin medication discontinuation and new antipsychotic use at six months post-hospital discharge. RESULTS:A total of 520,187 participants were included in the statin medication and 910,629 in the antipsychotic medication cohorts. Statin discontinuation ranged from 10-15% and new antipsychotic prescription fills from 2-4% across the three hospitalization groups, with highest rates in the ICU admission and sepsis diagnosis group. Statin discontinuation and new antipsychotic use after a hospitalization varied by hospital, with worse performing hospitals having 11% higher odds of discontinuing a statin (median odds ratio at hospital-level, adjusted for patient differences, aMOR: 1.11 (95% CI: 1.09, 1.13)) and 29% higher odds of new antipsychotic use (aMOR, 1.29 (95% CI: 1.24, 1.34)). Risk-adjusted hospital rates of these two medication changes were not correlated (p = 0.49). CONCLUSIONS:Systemic variation in the rates of statin medication continuation and new antipsychotic use were found.