Abstract
This study assesses the effectiveness of a pharmacy-led transition of care (TOC) service on increasing patients’ understanding of, and reported adherence to, medication post hospital discharge. A cross-sectional survey was administered to patients who were discharged from the hospital with at least one medication received via bedside delivery from the TOC service. Adherence was assessed by asking the patient if they had taken their discharge medications as instructed by the prescriber. Satisfaction with the discharge medication counseling service was assessed through a five-point Likert scale. Descriptive statistics were conducted for all questionnaire items and qualitative data was examined using content analysis. The majority of patients (73%) were counseled on their medication(s) before leaving the hospital. Among those who received counseling, 76 patients had a better understanding of their medication(s). Ninety-five percent of the patients reported adherence, and all six of the patients reporting non-adherence claimed they were not counseled on their medications prior to discharge. Many patients had questions regarding their medication during the follow-up phone call, substantiating the need for further follow-up with patients once they have left the hospital environment. The implementation of medication bedside delivery and counseling services, followed by outpatient adherence monitoring via a transitional care management service, can result in higher levels of reported medication adherence.
Highlights
Medication non-adherence is an important health care consideration that largely affects health outcomes as well as health care costs [1,2,3,4]
While medication adherence is a challenge in all care settings, it can be problematic for patients transitioning from an inpatient to outpatient setting following a hospital discharge, due to a variety of factors including changes in health status and new or adjusted medication lists [6,7]
While pharmacist intervention during and after hospitalization has been frequently studied in the areas of medication reconciliation and discharge counseling, or on the use of a follow-up phone call, this is one of the few studies that have assessed medication adherence post-discharge in a program that includes all of these factors alongside bedside delivery of medications [12,13,14,15,16,17,18,19]
Summary
Medication non-adherence is an important health care consideration that largely affects health outcomes as well as health care costs [1,2,3,4]. A 2014 study predicted that between $100–300 billion of avoidable health care costs can be credited to non-adherence, suggesting that interventions that increase medication adherence would improve both health and financial outcomes [5]. In the inpatient health care setting, education about medications often occurs at the time of patient discharge. Evidence still points to high rates of medication errors, adverse drug events, and patient nonadherence that occur following patient discharge from the hospital [8]
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