# Occurrence of Potential Prescribing Cascades After Hospital Discharge: A Cohort Study

## TL;DR

This study found that after hospital discharge, some patients received additional medications to treat side effects from their original prescriptions, often prescribed by different healthcare providers.

## Contribution

The study quantifies the occurrence of potential prescribing cascades post-discharge and identifies the role of external healthcare providers.

## Key findings

- The cumulative incidence of potential prescribing cascades ranged from 0% to 12.3% within one year after discharge.
- For 12 cascades, 31.8% to 92.8% of marker medications were prescribed by healthcare providers outside the hospital.
- Four cascades had incidences of at least 4%, indicating significant post-discharge medication management risks.

## Abstract

A prescribing cascade (PC) occurs when a medication (index) causes an adverse drug reaction (ADR), which is addressed by prescribing additional medication (marker). Medication initiated in the hospital may cause post‐discharge ADRs and PCs, especially when multiple healthcare providers are involved. The study aimed to assess the cumulative incidence of potential PCs post‐discharge and identify the healthcare providers involved in prescribing the marker medication.

A cohort study was conducted among adult patients admitted in one hospital between 2019 and 2023, who initiated medication associated with preselected PCs (n = 20). A PC was defined as the initiation of a marker medication which may be intended to treat an ADR induced by the index medication. Data from the hospital and the Nationwide Medication Record System were used to identify potential PCs post‐discharge. The primary outcome was the cumulative incidence of PCs, estimated for PCs with ≥ 10 patients initiating the index medication. The secondary outcome was the percentage of cases where the marker medication was prescribed by a healthcare provider outside the hospital, for PCs with ≥ 10 patients initiating the marker medication. Descriptive statistics were used.

Among 24 282 patients initiating index medication, 502 potential PCs were observed. The cumulative incidence was estimated for 17 PCs, ranging from 0% to 12.3%. Across 12 PCs with ≥ 10 patients, percentages of marker medications prescribed outside the hospital ranged from 31.8% to 92.8%.

The cumulative incidence of potential PCs post‐discharge can be substantial with marker medication often initiated by healthcare providers outside the hospital.

The cumulative incidence of potential prescribing cascades within 1 year after hospital discharge ranged from 0% to 12.3%, including four with previous strong evidence and current incidences of at least 4%.The medication used to treat a potential adverse drug reaction indicative for a prescribing cascade after discharge was often prescribed by a healthcare provider outside the hospital.These findings highlight the risks associated with transitions of care and indicate room for improvement of post‐discharge medication management.

The cumulative incidence of potential prescribing cascades within 1 year after hospital discharge ranged from 0% to 12.3%, including four with previous strong evidence and current incidences of at least 4%.

The medication used to treat a potential adverse drug reaction indicative for a prescribing cascade after discharge was often prescribed by a healthcare provider outside the hospital.

These findings highlight the risks associated with transitions of care and indicate room for improvement of post‐discharge medication management.