PT - JOURNAL ARTICLE AU - Rachel Denholm AU - Richard Morris AU - Sarah Purdy AU - Rupert Payne TI - Impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in England AID - 10.3399/bjgp20X709385 DP - 2020 Jun 01 TA - British Journal of General Practice PG - e399--e405 VI - 70 IP - 695 4099 - http://bjgp.org/content/70/695/e399.short 4100 - http://bjgp.org/content/70/695/e399.full SO - Br J Gen Pract2020 Jun 01; 70 AB - Background Little is known about the impact of hospitalisation on prescribing in UK clinical practice.Aim To investigate whether an emergency hospital admission drives increases in polypharmacy and potentially inappropriate prescriptions (PIPs).Design and setting A retrospective cohort analysis set in primary and secondary care in England.Method Changes in number of prescriptions and PIPs following an emergency hospital admission in 2014 (at admission and 4 weeks post-discharge), and 6 months post-discharge were calculated among 37 761 adult patients. Regression models were used to investigate changes in prescribing following an admission.Results Emergency attendees surviving 6 months (N = 32 657) had a mean of 4.4 (standard deviation [SD] = 4.6) prescriptions before admission, and a mean of 4.7 (SD = 4.7; P<0.001) 4 weeks after discharge. Small increases (<0.5) in the number of prescriptions at 4 weeks were observed across most hospital specialties, except for surgery (−0.02; SD = 0.65) and cardiology (2.1; SD = 2.6). The amount of PIPs increased after hospitalisation; 4.0% of patients had ≥1 PIP immediately before pre-admission, increasing to 8.0% 4 weeks post-discharge. Across hospital specialties, increases in the proportion of patients with a PIP ranged from 2.1% in obstetrics and gynaecology to 8.0% in cardiology. Patients were, on average, prescribed fewer medicines at 6 months compared with 4 weeks post-discharge (mean = 4.1; SD = 4.6; P<0.001). PIPs decreased to 5.4% (n = 1751) of patients.Conclusion Perceptions that hospitalisation is a consistent factor driving rises in polypharmacy are unfounded. Increases in prescribing post-hospitalisation reflect appropriate clinical response to acute illness, whereas decreases are more likely in patients who are multimorbid, reflecting a focus on deprescribing and medicines optimisation in these individuals. Increases in PIPs remain a concern.