The multicenter study collected data on 400 patients on discharge from hospital and 2 to 5 days after discharge between November 2019 and March 2020. All patients involved were at least 75 years old and suffered from polypharmacy, defined as taking at least 5 drugs. at a time. 69 other patients were eligible but did not participate.
Patients were asked about medication management using a combination of validated and self-developed questionnaires. Out of 400 participants who had been admitted to 12 hospitals in Flanders, Belgium, 70% were able to manage their medication on their own after discharge.
The study aimed to describe the self-management of drugs after discharge, in which the patient performs a set of actions to manage the drugs, and to describe the problems encountered with polypharmacy and to determine the associated factors.
Prior to hospitalization, approximately 78% of patients managed their medications entirely on their own. During hospitalization, that number fell to 13% while 74% of patients had nurses who managed their medications. Among these 13%, all patients received assistance in preparing their medicines but administered them independently. After discharge, 70% fully self-managed their mediations, 27% received help preparing their medications but self-administered, and 3% received help preparing and administering their medications at home.
According to the authors, although 70% is a high share of elderly patients who are able to manage their medications, this still leaves a large group struggling at the start of the self-management process.
The self-management process begins with filling and withdrawing a prescription, and the study found that many patients were already having problems at this point. Some reasons include not having the required prescriptions, not knowing who to contact, and not having the resources to obtain prescribed medications.
“The inability to obtain drugs compromises the whole process of self-management of drugs,” said the authors. “Therefore, before discharge from hospital, health care providers should assess whether patients are able to obtain their medicines and whether they can rely on (informal) caregivers to purchase medicines. “
Beyond this, the most common problem was that patients did not have adequate knowledge and understanding of their medications; 86% experienced at least 1 knowledge-related disability after their discharge. About three-quarters of patients did not know the names or strengths of all their prescriptions, and about two-thirds did not know the indication for all their medications after discharge from hospital.
The study concluded that the management of medications by nurses during hospitalization was a significant predictor of deficiency. The nurses took over the management of the patient’s medication in 74% of cases, thus disrupting the continuity of self-management in patients who managed their medication themselves before hospitalization.
“In day-to-day practice, allowing more patients to manage their medications on their own during their hospital stay could be beneficial,” the authors said.
There was also a link between self-medication and medication adherence. In one study, a significant proportion of geriatric patients, both intentionally and unintentionally, did not take or stopped taking their medications.
One of the main reasons for intentional non-compliance was side effects. Reasons for unintentional nonadherence included forgetting to take medications, physical inability to take the medications, and taking medications at the wrong time or in incorrect doses.
Overall, the multi-center study found that geriatric patients do not receive adequate instructions on self-management of medications after discharge from hospital.
“During hospitalization, health care providers need to identify and resolve self-management medication issues,” the authors concluded. “To prevent problems after discharge from hospital, hospital preparedness should be improved to support self-management of medications at home. “
Mortelmans L, De Baetselier E, Goossens E, Dilles T. What happens after discharge from hospital? drug management deficiencies encountered by geriatric polypharmaceutical patients. Int J Environ Public Health Res. Published online June 30, 2021. doi: 10.3390 / ijerph18137031