What do discharged patients know about their medication?

https://doi.org/10.1016/j.pec.2004.02.019Get rights and content

Abstract

Patient’s knowledge is a necessity for empowering patients to perform self-care, especially when dealing with new, ill-defined and unknown situations. The aim of this paper is to assess patients’ reported as opposed to correct knowledge about medication therapy after discharge from hospital and to identify factors that increase correct knowledge. Three hundred and forty-one patients were interviewed 7–14 days after discharge from six internal wards in a large medical facility in Israel. Most patients (73%) were aware of the course and purpose of their medication. They were, however, unaware of side effects, needed lifestyle changes, and correct medication schedules. A large difference was found between levels of reported and correct knowledge about various issues regarding medication treatment. No significant correlation was found between correct knowledge about medication therapy at discharge, and gender, age, education, patient satisfaction and wish for more counseling. The only factor which significantly affected levels of correct knowledge was whether the patient had received medication counseling during hospitalization. The findings illuminate the gap between patients’ perception of knowledge and actual knowledge. The study indicates the need for patient counseling during hospitalization, with respect to medication therapy.

Introduction

During the last decade there has been growing awareness of the importance of patients’ counseling at discharge from hospital. Counseling thus provides the individual with the knowledge which will enable him/her to achieve an optimal state of health [1]. That is, with counseling, a patient can take an active role in achieving health, coping with illness, and managing treatment. Informed patients are more likely to comply with drug treatment programs [2], [3], [4], [5], may be less anxious, more secure, and better able to take charge of their own medication and treatment schedule [6], [7], [8], [9].

However, studies that have examined levels of knowledge about treatment among patients discharged from hospital have shown especially low levels of knowledge about medication therapy. Information about medication covers aspects, such as purpose of medication therapy, dosage, scheduling, side effects, and required lifestyle changes. Although, the majority of patients were found to be aware of the purpose of the medication [2], [10], [11], [12], lack of knowledge regarding side effects, tests and lifestyle changes was quite glaring. O’Connell and Johnson [12] found that only 27% of the patients were aware of possible side effects related to their medication. Other studies obtained similar results [5], [10], [13], [14], [15]. Some researchers have found a serious lack of knowledge regarding medication among patients discharged from hospital, including knowledge about dosages [10], [11], [13], [14], [16], [17]. For example, Lee et al. [18] surveyed 220 patients discharged to their homes from two medical-surgical units. They found that 40% of the patients needed more specified directions for care, such as how or when to take medications.

Gilhar and Levy [11] found that only a small percentage of patients were aware of the importance of taking their medication at the appointed times, the relationship with meals, and the necessity of taking medication for the prescribed period. Similarly, patients were not aware of the side effects that could develop as a result of their medication and some patients were not informed as to what should be done if these side effects appeared.

Researchers have also reported differences in knowledge of newly prescribed drugs and those prescribed before hospitalization. Patients who were discharged with instructions to continue their previous medication had better knowledge about their medication than did patients who had been prescribed new medications [11]. Yet, Pullar et al. [10] found no differences in patients’ knowledge of newly prescribed medications as opposed to those previously prescribed.

Having to take an increased number of medications has been shown to adversely affect patients’ knowledge and appropriate use of medications. The growing amount and complexity of knowledge required with the increase in medication can result in too much information for a patient to process and remember correctly [15], [19], [20].

The patient can obtain knowledge and information about medication therapy from several sources such as counseling, written information, the Internet and so forth. Physicians and pharmacists tend to be the main source of this information. An additional source for hospital patients is the nurse, who can fulfill an important role in preparing the patient for discharge and improving his/her self-care abilities with regard to medication management [21]. Other findings indicate that patients did not regard nurses as an important source of medication information [12]. However, most patients reported they had not been given opportunity to ask questions about medication by any members of the healthcare team [5], [17].

Successful patient education or counseling can be evaluated by measurable outcomes: knowledge, changes in attitudes, health behavior and compliance with medication therapy. The most common way to evaluate patient education is to estimate the patient’s knowledge and understanding of his/her medication therapy [22].

The purpose of this study was to assess Israeli patients’ reported knowledge about medication therapy after discharge from hospital and to compare this knowledge with correct information. Another purpose was to assess the correlation between correct knowledge of medication therapy, and characteristics of medication counseling and patients’ demographic variables.

Section snippets

Method

A cross-sectional survey was performed in six internal medicine wards at a large medical facility in Israel.

Participants

A total of 540 patients met the criteria for inclusion and agreed to take part in the study. Twenty patients (4%) refused to be interviewed a week after discharge, health status prevented 97 (18%) from being interviewed, 48 (9%) could not be located because of changes in address or telephone number, re-hospitalization, or transfer to a different care framework, and 34 (6%) were discharged without ongoing medication. All together 341 (63%) patients were interviewed.

The average age of the

Discussion and conclusions

This study illustrates the need for patient counseling during hospitalization, at discharge and within the community setting regarding medication therapy.

We found that only 40% of the patients received medication counseling during hospitalization. The fact that patients mentioned that they wanted more information on medication may indicate that the counseling given was not adequate. This finding has been also reported by other authors as well [13], [18]. Moreover, most patients preferred to

Acknowledgements

The study was supported by a grant from the Israel National Institute for Health Policy and Health Services Research (NIHP). We thank all nursing staff from the internal medicine departments for their help in recruiting participants and collecting data.

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