[Difficulties in the transfer of drug therapy from inpatient to ambulatory treatment]. / Pharmakotherapeutische Transferproblematik von stationärer zu ambulanter Versorgung.

The prospective study compares prescribed drugs of 192 primarily cardiological patients at discharge and 7 weeks later in ambulatory care. The data were determined by discharge summaries and by standardized patient-questionnaires. The drug division was made with the ATC-classification according to the recommendations of the World Health Organisation for Drug Utilisation Studies. The intraindividual cost comparison was calculated by current pharmacy sale prices. The findings were changes in hospital discharge medications in ambulatory care in over 2/3 of the cases. The most frequent change was the additional prescribing of drug groups. The average daily tablet number increased in patients with the same or worsened subjective feeling after discharge. Additionally we found in a number of patients a change of drug therapy within the ATC-groups, or in fact, withdrawal of drug therapy all together. The frequency of changes increased with the number of patient/doctor contacts. The observation that the average daily therapeutical cost decreased just slightly could give an indication that cost saving was a minor part of the doctors decision for drug changing. However, the frequency of changes has shown to be dependent upon the specialities of the physician or pharmaceutical group.

[Prescribing practice for beta blockers at patient discharge to ambulatory care. A health care economic evaluation in a cardiology patient sample with special reference to drug budgeting]. / Verordnungspraxis von Betablockern an der Schnittstelle von stationärer zu ambulanter Versorgung. Eine gesundheitsökonomische Evaluation in einem kardiologischen Kollektiv under besonderer Berücksichtigung der Arzneimittelbudgetierung.

Beta blockers are known to reduce mortality from hypertension and coronary heart disease after myocardial infarction. Recent health care laws in Germany did impose a medication budget for ambulatory patients only. To evaluate the effects of this administrative instrument we studied prescribing practices of beta blockers in patients transferred from inpatient to ambulatory care. Specifically, we aimed of assessing the quality and cost effectiveness of beta blocker prescriptions. In a prospective cohort study of 142 patients discharged from a tertiary care center, the beta blocker medication was continued in 130 patients (91%). Adequate quality of the medication, defined as continuation of a beta blocker in sufficient dosage, was found in 77% of patients. Cost effective prescribing practices, defined as adequate quality at a lower cost than at discharge, were documented in 10% of the patients. However, inadequate dosage or even omitting of a beta blocker was found in 23% of patients. Overall, we found high-quality prescribing practices in more than two-thirds of our patients, but documented inadequate care in more than 20%. Our study did not document any consistent pattern between medication changes and cost-effective prescribing practices attributable to medication budgeting in Germany.