Download medication management after discharge from a rural district hospital

MEDICATION DISCREPANCIES AFTER
DISCHARGE FROM A
RURAL DISTRICT HOSPITAL
WHAT MEDICATIONS ARE OUR PATIENTS
TAKING AT HOME?
THE SCENARIO
THE STUDY
• HETI RURAL RESEARCH CAPACITY BUILDING
PROGRAM
• The aim of this study was to investigate the research
question: Are patients discharged from an Australian
rural hospital taking their medication as documented in
their hospital discharge summary within one month of
discharge?
METHOD
• This study used a cross sectional survey design which
involved using semi-structured telephone interviews of
patients discharged from the medical teams of a 162
bed general NSW based rural hospital.
• The semi-structured interview questions were designed
to ascertain whether there were any discrepancies
between medications documented on discharge from
hospital and those reported by the patient within a
month of discharge.
PARTICIPANTS
• 96 initially enrolled
• 71 (74%) finally interviewed:
• 14 could not contact
• 7 in another care facility
• 4 withdrew consent on telephone contact
• 66 finally analysed
• 5 no completed discharge summary
TELEPHONE QUESTIONNAIRE
• What medication are you taking now
• Prompt sheet
• Compared to medication documented on discharge
summary
DISCREPANCIES DOCUMENTED & CLASSIFIED
• Medical officer initiated
• Patient led
• Continuing previous regime
• Medication not considered significant – script not
filled
• Medication too expensive
• Medication caused side effects
• Other as specified by patient
CHARACTERISTICS
Mean (range)
Age in years
75 (42-92)
Length of stay days
5.5 (2-26)
Number of medications on discharge summary
8.8 (2-19)
Median number of medication on discharge summary
9 ( 6-10.8) *
Number of medication changes during admission from discharge
3 (0-10)
summary
N (%)
Gender
Male
31 (47%)
Female
35 (53%)
Principal Diagnosis †
Diseases and disorders of the respiratory system
10 (15.2%)
Diseases and disorders of the circulatory system
20 (30.3%)
Diseases and disorders of the musculoskeletal system and
7 (10.6%)
connective tissue
Infectious and parasitic diseases
11 (16.7%)
Appointment with Medical officer post discharge
Within 7 days (46 with GP 3 with specialist)
Longer than 7 days
No medical officer appointment between
discharge and follow up phone call (>13 days)
Discharge information given at discharge – as
reported by participant (%)
Yes
No
Don’t remember
Pharmacy Medication list given - as reported by
participant
Yes
No or don’t remember
55 (83%)
49 (74%)
6 (9%)
11 (17%)
25 (38%)
29 (44%)
12 (18%)
45 (68%)
21 (32%)
Medication manager
Self
Carer
Both
Adherence Measure¶
Low
Medium
High
Dosage Administration Aid used
Yes
No
50 (77%)
12 (18%)
4 (6%)
13 (20%)
14 (21%)
39 (59%)
20 (33%)
46 (66%)
RESULTS – NUMBER OF DISCREPANCIES PER
PARTICIPANT
TYPE OF DISCREPANCIES
NUMBER OF
DISCREPANCIES PER
PARTICIPANT
NUMBER OF
PARTICIPANTS
DRUG
CHANGED
SAME
DOSE
TOTAL NUMBER
OF
DISCREPANCIES
CHANGED
ADDITIONS
OMISSIONS
CLASS
0
5
0
0
0
0
0
1
8
4
3
0
1
8
2
19
18
11
4
5
38
3
10
22
4
1
3
30
4
6
16
8
0
0
24
5
6
17
9
2
2
30
6
5
23
4
1
2
30
7
3
18
0
1
2
21
>8
4
30
12
1
4
47
OR TO PUT IT A DIFFERENT WAY….
TYPE OF DISCREPANCIES
NUMBER OF
DISCREPANCIES PER
PARTICIPANT
NUMBER OF
PARTICIPANTS
DRUG
CHANGED
SAME
DOSE
TOTAL NUMBER
OF
DISCREPANCIES
CHANGED
ADDITIONS
OMISSIONS
CLASS
0
5
0
0
0
0
0
1 or more
61
148
51
10
19
228
3 or more
33
124
38
5
13
180
5 or more
18
88
26
5
10
129
8 or more
4
30
13
1
4
48
TYPE OF DISCREPANCIES
N (%)
TOTAL NUMBER OF DISCREPANCIES
ADDITIONS – COMPARED TO DISCHARGE SUMMARY
ADDITIONS - EXCLUDING OTC AND CAM
OMISSIONS – COMPARED TO DISCHARGE SUMMARY
OMISSIONS – EXCLUDING OTC AND CAM
CHANGED DRUG – SAME PHARMACOLOGICAL CLASS CHANGED DOSE - COMPARED TO DISCHARGE SUMMARY
228 (100%)
148
(65%)
82
(36%)
51
(22.4%)
45
(19.7%)
10
(4.4%)
19
(8.3%)
ADDED MEDICATION
DRUG GROUP
EXAMPLE OF MEDICATIONS
Analgesics
Oxycodone, paracetamol/codeine, tramadol, gabapentin
Blood
and Warfarin x 2, Potassium chloride,
electrolytes
Cardivascular
amiodarone, atorvastatin, digoxin, diltiazem, frusemide,
glyceryl trinitrate patch, spironolactone, telmisartan +
hydrochlorothiazide
Endocrine
risedronate
Gastrointestinal
esomeprazole, pantoprazole, sucralfate
Genitourinary
oxybutynin
Immunomodulators prednisolone
Muscular skeletal
allopurinol
Psychotropic
diazepam, mirtazepine, nitrazepam, risperidone
Respiratory
salbutamol, tiotropium, Seretide®,
Symbicort®,
(numerous)
OMITTED MEDICATION
DRUG GROUP
ANALGESICS
BLOOD AND ELECTROLYTES
CARDIVASCULAR
MEDICATIONS
Gabapentin, oxycodone
Aspirin x 4, potassium chloride,
diltiazem, irbesartan + hydrochlorothiazide,
spironolactone,
EAR NOSE THROAT
GASTROINTESTINAL
betahistine
esomeprazole, pantoprazole, prochlorperazine,
metoclopramide
GENITOURINARY
RESPIRATORY
Prazosin tamsulosin
Bromhexine, tiotropium, ‘Seretide’, ‘Symbicort’
OTC AND CAM
calcium,
cyanocobalamin,
thiamine, vitamin D
magnesium,
REASON FOR DISCREPANCY
REASON
MEDICAL OFFICER THERAPEUTIC CHANGE POST DISCHARGE - NUMBER OF
INTENTIONAL DISCREPANCIES (%)
PARTICIPANT LED CHANGE – TOTAL
155 (68%)
PARTICIPANT CONTINUING PREVIOUS REGIME
PRESCRIBED
MEDICATION THOUGHT NOT NECESSARY
SCRIPT OR BUY MEDICINE
PARTICIPANT DIDN’T KNOW OF CHANGES/FORGOT
N (%)
73 (32%)
129 (57%)
–
DIDN’T FILL
20
(9%)
MEDICATION TOO EXPENSIVE
4
(2%)
1 (0.4%)
MEDICATION CAUSED SIDE EFFECT – CEASED
1 (0.4%)
CONCLUSIONS
• In conclusion, this study has demonstrated that within a
month after discharge from an Australian rural hospital
the participants are not taking their medication as
documented in their hospital discharge summary.
RECOMMENDATION
• This study has demonstrated a problem with the
continuity of care in terms of medication discrepancy
for patients discharged from our rural hospital.
• Medication reconciliation at all points of the health
care cycle
• MMP
• Improved communication of changes
• eHealth???