Medication InformationInformation needs about medication according to patients discharged from a general hospital
Introduction
Treatment regimens before and after hospital discharge are often different and these discrepancies may lead to an increased risk of patient harm after hospital discharge [1]. Medication reconciliation is an important tool to reduce medication errors and is defined as ‘the process of obtaining and maintaining a complete and accurate list of the current medication use of a patient across healthcare settings’ [2]. This process includes verification of medication lists, pharmacotherapeutic evaluation of the quality of pharmacotherapy and communication to the next health care provider(s). These activities lead to interventions that can prevent patient harm by changes in prescriptions or support of optimal medication use by the patient. Examples of such interventions are stopping incorrectly prescribed drugs (digoxin prescribed for another patient) or adding drugs based on best practice standards (a laxative added to opioid treatment) [3]. However, the patient is not necessarily included in this process [4].
The patient has been recognised as a valuable source of information: he provides the additional information on drug use or needs in drug therapy compared to sources that do not include the patient [3], [5]. Moreover, inclusion of the patient in information transfer offers the opportunity to counsel the patient on optimal drug use and improves knowledge about medication. In general, knowledge about medication and information on drug use improve medication adherence, thus enabling treatment targets to be reached in patients with varying diseases [6], [7].
Patients express that they need information about medication as they are discharged from the hospital, and rate this highly compared to other informational needs around discharge [8]. In practice, only a small proportion of patients (49%) was educated about medication at discharge, and an even smaller proportion (30%) reported to have received written information [9]. Complicating in information transferral at discharge is that many patients are relatively vulnerable [10] and limited in their time and capacity to comprehend information [11]. In this context the question is what information about medication should be provided to patients at hospital discharge.
In several studies patient's informational needs were topic of research. Most studies found that basic information about medication is wanted, such as the names of the different drugs, dosing schedule and indication [12]. Important side effects of medication were often not told in a way patients could understand them, but patients wanted to be informed about possible side effects [12], [13]. Also, patients would like to receive information about the treatment options that were available [12]. Currently, most (educational) discharge activities are based on opinions of health care professionals [14]. To our knowledge, no study has explored the needs of information about medication at hospital discharge according to the patient.
As the patient perspective is important in the further development of patient counselling about discharge medication, we performed a qualitative study in which the viewpoints of patients were investigated. The goal of the study was to explore the needs of patients on information about medication at hospital discharge.
Section snippets
Patient information in the hospital
During the study period, an intervention in patient counselling was implemented in the St. Lucas Andreas Hospital, a 550 bed general teaching hospital [3]. This intervention facilitated the inclusion of both patients who received usual care (no patient counselling) and patients who received the intervention (counselling at discharge). Patients from three wards received usual care: patients at the pulmonology ward before implementation of the intervention, and patients from the internal medicine
Patient characteristics
Between March and June 2007, 34 patients were approached for an interview. A total of 31 patients was included in the study: three patients could not be interviewed because the actual moment of discharge was before the moment the interview was scheduled. Table 2 summarizes the characteristics of the patients.
Aspects emerging from the analysis
From the interviews, four aspects emerged as important issues in information about medication at discharge: (1) basic information (i.e. name of drug, indication and use), (2) information
Discussion
Patients had variable needs concerning information about discharge medication. Most patients wanted to receive basic information about their medication concerning the goal of pharmacotherapy, dosing and usage. Reasons for not wanting information were that patients trusted their health care professionals and did not consider information useful. However, patients that received patient counselling appreciated the information. Other important informational aspects were side effects, alternatives
Body giving ethical approval
This study was exempt from review by the institutional review board, as this did not affect the patient's integrity. Patient data were sampled and stored in accordance with Dutch privacy regulations.
Competing interest
None.
Acknowledgements
We wish to thank all the patients for their contribution to this study, the pharmaceutical consultants and all doctors, nurses and assistants at the wards for their cooperation.
I confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story.
References (30)
- et al.
Effects of a structured patient-centered discharge interview on patients’ knowledge about their medications
Am J Med
(2004) - et al.
Factors influencing patients’ informational needs at time of hospital discharge
Patient Educ Couns
(1990) - et al.
The significance for decision-making of information that is not exchanged by patients and health professionals during consultations
Soc Sci Med
(2006) - et al.
Unmet needs in the medication use process: perceptions of physicians, pharmacists, and patients
J Am Pharm Assoc
(2003) - et al.
Relationship of in-hospital medication modifications of elderly patients to postdischarge medications, adherence, and mortality
Ann Pharmacother
(2008) - The Institute for Healthcare Improvement. Protecting 5 million lives from harm. Getting started kit: prevent adverse...
- et al.
Effect of medication reconciliation with and without patient counseling on the number of pharmaceutical interventions among patients discharged from the hospital
Ann Pharmacother
(2009) Medication reconciliation handbook
(2006)- et al.
Medication reconciliation at hospital discharge: evaluating discrepancies
Ann Pharmacother
(2008) - et al.
Patients’ knowledge of drug treatments after hospitalisation: the key role of information
Swiss Med Wkly
(2007)