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Background: Pharmacotherapy in old age is a very complex process during which adherence to medication recommendations is a key point. Little is known about general practitioner (GP)-related barriers to prescribing medication according to geriatrician recommendations. Objective: To provide a snapshot of the reality of continuity of care and information about factors that modulate GP adherence. Design: Observational and prospective pilot study. Setting: One academic center of geriatric rehabilitation and the associated community. Measurements: Number of prescribed medications at admission time, discharge and four months later. GP attitudes were investigated using a short and specific questionnaire (14 items, 5 minutes to respond). Participants: Consecutive patients discharged from the Strasbourg hospital geriatric division whose reference GP was known. 150 patients (84.8±6.5 years-old; 69.3% women) were included and their GPs contacted by telephone. Of the 72 GPs who accepted to participate, 39 GPs answered the first part of the survey and 24 completed the entire survey. Results: The cohort of 150 patients suffered from 4.9±2.1 co-morbidities and took 8.4±3.2 medications at admission time and 7.9±3.0 upon their discharge (p=0.038). The 39 patients associated with GPs who responded were not different compared to the initial cohort. During their hospital stay, 79 therapeutic modifications were done with a 10.5% overall reduction in the number of treatments (p=0.03). Four months later, a further 16.0% reduction was observed (p=0.02). The most modified therapeutic classes were ACE inhibitors, (β-blockers, statins, oral anticoagulants and proton pomp inhibitors. (4 months later, patients were back to the initial number of medication even more?). According to GPs’ answers, 58.0% were satisfied with the medical reports (sent 3 to 4 weeks after hospital discharge) in terms of expectations and the quality. For 91.6%, GPs considered that the therapeutic changes were mentioned in the report, and 83.3% were properly explained. The usefulness of the report was highlighted by 83.0% while 46.0% judged that the optimization of prescribing medications at discharge did not facilitate patient management. At 4 months, 60.9% of GPs had made further therapeutic modifications. Weakness in transition and continuity of care were particularly underlined by the last open-ended question of the questionnaire. Conclusion: This pilot study emphasizes that hospital discharge is a crucial time for non-adherence and reinforces the need not only to enhance the quality of transition but also the continuity of care between hospital and community.

Adherence To Long-Term Complex Medication Regimen After Hospital Discharge From An Academic Geriatric Center: General Practitioners’ Attitude