Informational needs and recall of in-hospital medication changes of recently discharged patients

Eibergen, Liesbeth; Janssen, Marjo J. A.; Blom, Lyda; Karapinar-Çarkıt, Fatma

doi:10.1016/j.sapharm.2017.01.006

Cited by 42 publications

(47 citation statements)

References 17 publications

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“…6,13,18,36 Although less frequently assessed, lower health literacy and cognition were also associated with knowledge deficits. 10,38 Other demographic factors, such as gender, marital status, length of hospital stay, and total number of medications prescribed were not associated with patient understanding. 6,8,13,16 Given these findings, providers could consider targeting educational interventions to older patients and those with barriers to learning about their health.…”

Section: Discussionmentioning

confidence: 95%

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Hospitalized Patients’ Knowledge of Care: a Systematic Review

et al. 2018

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BACKGROUND: Patients' comprehension of their medical conditions is fundamental to patient-centered care. Hospitalizations present opportunities to educate patients but also challenges to patient comprehension given the complexity and rapid pace of clinical care. We conducted a systematic review of the literature to characterize the current state of inpatients' knowledge of their hospitalization, assess the methods used to determine patient comprehension, and appraise the effects of interventions on improving knowledge. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library for articles published from January 1, 1995 through December 11, 2017. Eligible studies included patients under inpatient or observation status on internal medicine, family medicine, or neurology services. We extracted study characteristics (author, year, country, study design, sample size, patient characteristics, methods, intervention, primary endpoints, results) in a standardized fashion. The quality of observational studies was assessed using the NIH Quality Assessment Tool for Observation Cohort and Cross-Sectional Studies and the quality of interventional studies was assessed using adapted EPOC criteria from the Cochrane Collaboration. RESULTS: Twenty-eight studies met the criteria for inclusion, including 17 observational studies and 11 interventional studies. Patient knowledge of all aspects of their hospitalization was poor and patients often overestimated their knowledge. Older patients and those with lower education levels were more likely to have poorer knowledge. Intervention methods varied, but generally showed improvements in patient knowledge. Few interventional studies assessed the effect on health behaviors or outcomes and those that did were often underpowered. DISCUSSION: Clinicians should be aware that comprehension is often poor among hospitalized patients, especially in those with lower education and advanced age. Our results are limited by overall poor quality of interventional studies. Future research should use objective, standardized measures of patient comprehension and interventions should be multifaceted in approach, focusing on knowledge improvement while also addressing other factors influencing outcomes.knowledge and health behaviors (e.g., medication adherence) and clinical outcomes (e.g., hospital readmission), though this was not the primary aim of the review.A medical librarian (J.P.), with training in systematic review methodology, searched MEDLINE, EMBASE, and the Cochrane Library for articles published from January 1, 1995 through December 11, 2017. The following subject terms and keywords were used: inpatients, knowledge, comprehension, hospitalization, patient discharge, discharge planning, and goals of patient care (Appendixes 1, 2, and 3). We limited results to English language publications of randomized controlled trials, prospective analyses, retrospective analyses, case control, cohort, cross-sectional, and non-controlled before-and-after studies that were published in peer-reviewed journal...

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Section: Discussionmentioning

confidence: 95%

“…Similar to Vrhovac, Eibergen et al evaluated 124 patients' knowledge of changes to chronic medications. 38 One week after discharge, 42% could correctly recall all of the medication changes. Recall was better for dose and frequency changes (51%) than for switched medications (40%) and discontinued medication (38%).…”

Section: Observational Studiesmentioning

confidence: 98%

Hospitalized Patients’ Knowledge of Care: a Systematic Review

et al. 2018

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“…The DMR service provides a structured approach to information sharing, overcoming the major organisational-level and individual-level factors affecting the medication reconciliation process,25 and an opportunity for a face-to-face discussion and counselling with the patient to account for their changing needs postdischarge. Literature reports that patients’ information needs are individual, and even when counselled by hospital pharmacists only half of the patients could recall information related to medication changes 26. Unlike other systems in the UK, the DMR service is available nationally across Wales, and from April 2020 a new functionality will become available in the system, so that outcome data completed by community pharmacists will be available to view in the hospital where the referral was generated.…”

Section: Discussionmentioning

confidence: 99%

Exploring the association of the discharge medicines review with patient hospital readmissions through national routine data linkage in Wales: a retrospective cohort study

et al. 2020

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ObjectiveTo evaluate the association of the discharge medicines review (DMR) community pharmacy service with hospital readmissions through linking National Health Service data sets.DesignRetrospective cohort study.SettingAll hospitals and 703 community pharmacies across Wales.ParticipantsInpatients meeting the referral criteria for a community pharmacy DMR.InterventionsInformation related to the patient’s medication and hospital stay is provided to the community pharmacists on discharge from hospital, who undertake a two-part service involving medicines reconciliation and a medicine use review. To investigate the association of this DMR service with hospital readmission, a data linking process was undertaken across six national databases.Primary outcomeRate of hospital readmission within 90 days for patients with and without a DMR part 1 started.Secondary outcomeStrength of association of age decile, sex, deprivation decile, diagnostic grouping and DMR type (started or not started) with reduction in readmission within 90 days.Results1923 patients were referred for a DMR over a 13-month period (February 2017–April 2018). Provision of DMR was found to be the most significant attributing factor to reducing likelihood of 90-day readmission using χ2 testing and classification methods. Cox regression survival analysis demonstrated that those receiving the intervention had a lower hospital readmission rate at 40 days (p<0.000, HR: 0.59739, CI 0.5043 to 0.7076).ConclusionsDMR after a hospital discharge is associated with a reduction in risk of hospital readmission within 40 days. Linking data across disparate national data records is feasible but requires a complex processual architecture. There is a significant value for integrated informatics to improve continuity and coherency of care, and also to facilitate service optimisation, evaluation and evidenced-based practice.

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“…This suggests that more patient engagement is needed not only during hospitalization, but also in the discharge process and the period after hospitalization, especially for pharmaceutical care. This could be achieved by several methods, such as the use of lay language, asking patients what they want to know regarding their medicines, providing written information, repeating information or using the ‘teach‐back’ method, which is a strategy in which patients are asked to restate information that has been presented to them . As previous studies have shown that patients’ needs can increase after discharge, also a follow‐up phone call after discharge could be helpful to identify and to prevent medication‐related problems .…”

Section: Discussionmentioning

confidence: 99%

Patients’ and providers’ perspectives on medication relatedness and potential preventability of hospital readmissions within 30 days of discharge

Uitvlugt

Janssen

Siegert

et al. 2019

Health Expectations

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Background: Hospital readmissions are increasingly used as an indicator of quality in health care. One potential risk factor of readmissions is polypharmacy. No studies have explored the patients' perspectives on the medication relatedness and potential preventability of their readmissions. Objective:To compare the patients' perspectives on the medication relatedness and potential preventability of their readmissions with the providers' perspectives. Methods:Patients unplanned readmitted within 30 days after discharge at one of the participating departments of OLVG Hospital in Amsterdam were interviewed during their readmission. Patients' perspectives regarding medication relatedness of their readmissions, the potential preventability, possible preventable interventions, and satisfaction with medication information were examined. Health-care providers also reviewed files of these readmitted patients. Primary outcome was the percentage of medication-related and potentially preventable readmissions according to the patient vs the provider. Descriptive data analysis was used.Results: According to patients, 36 of 172 (21%) readmissions were medication-related, and of these, 21 (58%) were potentially preventable. According to providers, 26 (15%) readmissions were medication-related and 6 (23%) of these were potentially preventable. Patients and providers agreed on the medication relatedness in 11 of the 172 readmissions, and in two of these, agreement on the potential preventability existed. According to patients, preventive interventions belonged mostly to the hospital level, followed by the primary care level and patient level. Conclusion:Patients and providers differ substantially on their perspectives regarding the medication relatedness and preventability of readmissions. Patients were more likely to view medication-related readmissions as preventable. | 213UITVLUGT eT aL.

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Informational needs and recall of in-hospital medication changes of recently discharged patients

Cited by 42 publications

References 17 publications

Hospitalized Patients’ Knowledge of Care: a Systematic Review

Hospitalized Patients’ Knowledge of Care: a Systematic Review

Exploring the association of the discharge medicines review with patient hospital readmissions through national routine data linkage in Wales: a retrospective cohort study

Patients’ and providers’ perspectives on medication relatedness and potential preventability of hospital readmissions within 30 days of discharge

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