Functional Health Literacy and Understanding of Medications at Discharge

Maniaci, Michael J.; Heckman, Michael G.; Dawson, Nancy L.

doi:10.4065/83.5.554

Cited by 69 publications

(78 citation statements)

References 21 publications

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“…For example, other studies report at least some understanding of new medications among 64-68 % of patients; 16,17,25 the corresponding rate in our study was 53.2 %. These low rates of understanding existed despite the fact that we allowed patients to consult discharge instructions or other documentation in answering the survey, excluded clearly cognitively impaired patients, and excluded medication changes that were potential provider errors.…”

Section: Discussionsupporting

confidence: 60%

“…10,11 A 1999 study of 342 patients found that 54 % had inadequate knowledge of their medications 1 week after discharge; 12 other smaller studies show similar results. [13][14][15][16][17] Nonetheless, physicians grossly overestimate patient understanding. 15 No study has simultaneously evaluated medication reconciliation accuracy and patient understanding to form a comprehensive view of medication problems associated with hospitalization.…”

Section: Introductionmentioning

confidence: 99%

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Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

et al. 2012

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BACKGROUND: Adverse drug events after hospital discharge are common and often serious. These events may result from provider errors or patient misunderstanding. OBJECTIVE: To determine the prevalence of medication reconciliation errors and patient misunderstanding of discharge medications. DESIGN: Prospective cohort study SUBJECTS: Patients over 64 years of age admitted with heart failure, acute coronary syndrome or pneumonia and discharged to home. MAIN MEASURES:We assessed medication reconciliation accuracy by comparing admission to discharge medication lists and reviewing charts to resolve discrepancies. Medication reconciliation changes that did not appear intentional were classified as suspected provider errors. We assessed patient understanding of intended medication changes through post-discharge interviews. Understanding was scored as full, partial or absent. We tested the association of relevance of the medication to the primary diagnosis with medication accuracy and with patient understanding, accounting for patient demographics, medical team and primary diagnosis. KEY RESULTS: A total of 377 patients were enrolled in the study. A total of 565/2534 (22.3 %) of admission medications were redosed or stopped at discharge. Of these, 137 (24.2 %) were classified as suspected provider errors. Excluding suspected errors, patients had no understanding of 142/205 (69.3 %) of redosed medications, 182/223 (81.6 %) of stopped medications, and 493 (62.0 %) of new medications. Altogether, 307 patients (81.4 %) either experienced a provider error, or had no understanding of at least one intended medication change. Providers were significantly more likely to make an error on a medication unrelated to the primary diagnosis than on a medication related to the primary diagnosis (odds ratio (OR) 4.56, 95 % confidence interval (CI) 2.65, 7.85, p<0.001). Patients were also significantly more likely to misunderstand medication changes unrelated to the primary diagnosis (OR 2.45, 95 % CI 1.68, 3.55), p<0.001). CONCLUSIONS: Medication reconciliation and patient understanding are inadequate in older patients postdischarge. Errors and misunderstandings are particularly common in medications unrelated to the primary diagnosis. Efforts to improve medication reconciliation and patient understanding should not be diseasespecific, but should be focused on the whole patient.

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

et al. 2012

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“…1 Further, upon discharge from the hospital, patients often do not receive the necessary education and follow-up to prevent otherwise avoidable readmissions. [2][3][4] The widespread need for enhanced care and support measures for individuals with chronic disease led to a new arena of health care-chronic care management (CCM), defined as coordinated health care interventions and communications for populations with conditions that require significant self-care efforts. 5 Proactive CCM has been widely adopted as a means to improve quality and thereby reduce unnecessary health care utilization and expenditure.…”

Section: Introductionmentioning

confidence: 99%

The Impact of a Proactive Chronic Care Management Program on Hospital Admission Rates in a German Health Insurance Society

Hamar

Wells

Gandy

et al. 2010

Population Health Management

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Hospital admissions are the source of significant health care expenses, although a large proportion of these admissions can be avoided through proper management of chronic disease. In the present study, we evaluate the impact of a proactive chronic care management program for members of a German insurance society who suffer from chronic disease. Specifically, we tested the impact of nurse-delivered care calls on hospital admission rates. Study participants were insured individuals with coronary artery disease, heart failure, diabetes, or chronic obstructive pulmonary disease who consented to participate in the chronic care management program. Intervention (n ¼ 17,319) and Comparison (n ¼ 5668) groups were defined based on records of participating (or not participating) in telephonic interactions. Changes in admission rates were calculated from the year prior to (Base) and year after program commencement. Comparative analyses were adjusted for age, sex, region of residence, and disease severity (stratification of 3 [least severe] to 1 [most severe]). Overall, the admission rate in the Intervention group decreased by 6.2% compared with a 14.9% increase in the Comparison group (P < 0.001). The overall decrease in admissions for the Intervention group was driven by risk stratification levels 2 and 1, for which admissions decreased by 8.2% and 14.2% compared to Comparison group increases of 12.1% and 7.9%, respectively. Additionally, Intervention group admissions decreased as the number of calls increased (P ¼ 0.004), indicating a dose-response relationship. These findings indicate that proactive chronic care management care calls can help reduce hospital admissions among German health insurance members with chronic disease.

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“…68 Growing evidence suggests that older patients have poorer functional health literacy regarding medications. 69 Care transitions are an active area of research, and multiple studies have shown lower rates of rehospitalization with comprehensive transitional care programs involving ''transition coaches'' or advance practice nurses providing home visits and follow-up telephone calls. 70,71 More research is needed in this area to develop simple, cost-effective care transitions programs.…”

Section: Discharge Planning For An Elderly Patient Should Start Earlymentioning

confidence: 99%

Ten ways to improve the care of elderly patients in the hospital

Labella

Merel

Phelan

2011

Journal of Hospital Medicine

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Hospitalists care for elderly patients daily, but few have specialized training in geriatric medicine. Elderly patients, and in particular the very old and the frail elderly, are at high risk of functional decline and iatrogenic complications during hospitalization. Other challenges in caring for this patient population include dosing medications safely, preventing delirium and accidental falls, and providing adequate pain control. Ways to improve the care of the hospitalized elderly patient include the following: screening for geriatric syndromes such as delirium, assessing functional status and maintaining mobility, and implementation of interventions that have been shown to prevent delirium, accidental falls, and acute functional decline in the hospital. This article addresses these issues with 10 evidence‐based pearls developed to help hospitalists provide optimal care for this expanding population. Journal of Hospital Medicine 2011;6:351–357. © 2011 Society of Hospital Medicine

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Functional Health Literacy and Understanding of Medications at Discharge

Cited by 69 publications

References 21 publications

Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

The Impact of a Proactive Chronic Care Management Program on Hospital Admission Rates in a German Health Insurance Society

Ten ways to improve the care of elderly patients in the hospital

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