Assessing the maintenance of hospital discharge prescriptions in the older population: a systematic literature review

The transition of patients from hospital to primary care can generate medication errors. The maintenance of discharge prescriptions in older patients after hospitalization reflects the quality communication between hospitals and primary care. To assess the maintenance of hospital discharge prescriptions by community general practitioners. We carried out a systematic literature review of research studies reporting a proportion of maintenance of discharge prescriptions by general practitioners. We searched Medline, Cochrane, Embase and Clinicaltrials.gov. We included studies on older patients, hospitalized for any cause and discharged home. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. The maintenance proportions across studies were represented using a forest plot. Eleven studies were included. Ten reported a proportion of maintenance of discharge prescriptions higher than 50%. Seven studies were specifically interested in the maintenance of in-hospital modifications and reported high proportions of prescription maintenance by general practitioners (between 53.3 and 88.5%). Deletions were widely accepted by general practitioners (between 88.3 and 92.7%). Five studies, where medication reconciliation was carried out, reported high maintenance proportions (between 76 and 88.5%). The delay in prescription by the general practitioner did not seem to influence the proportion of maintenance. The heterogeneity in designs and settings among the studies limited the comparison between these proportions. This systematic review shows a high proportion of maintenance of discharge prescriptions in older patients by general practitioners. Interventions, such as medication reconciliation, may improve the maintenance of modification of discharge prescriptions by general practitioners.