Use of medication and investigations in community hospitals and a district general hospital: a cohort study of emergency admissions in the elderly

Abstract

Background: We previously studied clinical outcomes in two cohorts of emergency admissions of patients aged over 70 to one district general hospital (DGH) or five community hospitals (CHs) finding no differences in death, readmissions, or quality of life at 6 months after admission. Our objectives in this study were to examine the use and cost of medication and use and cost of investigations in the two different hospital settings. Methods: We identified and priced all medication taken on admission, during the hospital stay, and on discharge, and identified all investigations. The main outcome measures were number and cost of medications and investigations during the stay, and the difference in the patients' routine medication before and after the hospital stay. Results: Three hundred and seventy five patients were studied (DGH 170, CH 205). The median (inter-quartile range (IQR)) number and cost of drugs used during the hospital stay was higher in DGH patients: 11 (8, 17) drugs than CH patients: 8 (5, 11); (P < 0.001), costing £35 (13, 90) and £16 (6, 45) respectively (P < 0.001). DGH patients had a mean of 0.55 drugs added to their routine medication, at an extra projected cost of £9.50 per month, whereas CH patients had an average of 0.11 drugs removed from their routine medication at a projected cost saving of £1.35 per month (P = 0.012 for number and <0.001 for cost). More investigations were performed in the DGH than the CH; DGH median (IQR) £260 (180, 410); CH median £40 (9, 110). Conclusions: Considerable extra resources are used in emergency admissions of the elderly to a DGH. However, these extra resources do not appear to yield mortality or morbidity benefits.