Impact of a Pharmacy-Led Transition of Care Service on Post-Discharge Medication Adherence

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.

Update: Interim Guidance for Health Care Professionals Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use–Associated Lung Injury and for Reducing the Risk for Rehospitalization and Death Following Hospital Discharge — United States, December 2019

“…However, clinicians working closely with CDC have reported that rehospitalized EVALI patients have at times not adhered to prescribed corticosteroid tapers (Lung Injury Response Clinical Working Group, personal communication, December 2019). Patient adherence to prescribed medications has been determined to be enhanced by inpatient pharmacist counseling before patient discharge (19,20) and that such counseling decreases rehospitalization. Thus, part of EVALI patient discharge planning should include inpatient pharmacist counseling, particularly for patients on a corticosteroid taper.…”

Student-Led discharge counseling program for High-Risk medications in a teaching hospital in Saudi Arabia: A pilot study

“…The PSQSP survey results clearly showed patient satisfaction with the pharmacy services resulting in a mean score of 3.94 out of 4. Both high recall rate and satisfaction with care may boost patient’s adherence to their medications ( Gu et al, 2008 , Stroud et al, 2019 ). Furthermore, Stroud et al demonstrated the importance of follow up phone call on improving patient adherence in pharmacist-led TOC program ( Stroud 2019 ).…”

“…Different models exist for integrating pharmacist service into TOC programs ( Rochester-Eyeguokan 2016 ). A typical model involves the pharmacist conducting medication reconciliation, delivering patient-centered education, and resolving medication access issues during care transitions ( Stroud 2019 ). Such a model also involved pharmacist performing follow-up services to ensure patients adherence to their medication regimens without adverse outcomes upon returning to their homes.…”

A Follow-Up Phone Call to Post-Operative Patients Using the Five A’s

“…A study done in 2019 found that when patients were educated properly on opioid use, patients took opioids for fewer postoperative days (Farley et al, 2019). One article found that when contacting patients after discharge, many of the patients still had questions about their medication and instructions (Stroud, Adunlin, & Skelley, 2019). The study identified 32% of patients still had questions even when counseled in the hospital, the results stress the importance of implementing a post-discharge follow-up phone call addressing questions and concerns the patient may have (Stroud, Adunlin, & Skelley, 2019).…”

“…One article found that when contacting patients after discharge, many of the patients still had questions about their medication and instructions (Stroud, Adunlin, & Skelley, 2019). The study identified 32% of patients still had questions even when counseled in the hospital, the results stress the importance of implementing a post-discharge follow-up phone call addressing questions and concerns the patient may have (Stroud, Adunlin, & Skelley, 2019). The 5 A's Behavior Change Model is a patient centered counseling tool to encourage certain behavioral habits (Welzel et al, 2018).…”