Uncovering a multitude of sins: medication management in the home post acute hospitalisation among the chronically ill

Abstract

Background: Sub-optimal use of prescribed medication is often associated with unplanned hospitalisation among the chronically ill. Aims: To examine the extent of sub-optimal use of prescribed medication in a ‘high risk’ patient cohort recently discharged from acute hospital care. Methods: Chronically ill patients discharged from acute hospital care (n=342) were studied. At one week post discharge a home visit was performed by a nurse and a pharmacist during which medication management (including compliance and medication—related knowledge) was assessed. Results: During the majority of home visits at least one medication-related problem was detected: approximately half of the cohort subject to a ‘reliable’ pill-count were found to be mal-compliant and almost all demonstrated inadequate medication-related knowledge. Mal-compliance was correlated with ≥ five prescribed medications (Odds ratio [OR] 2.6: p <0.002). Comparatively, lower medication-related knowledge was correlated with age >75 years (OR 2.2: p <0.001), exacerbation of pre-existing chronic illness (OR 2.7: p=0.044) and six years formal education (OR 1.9: p≥0.004). Neither were modulated by extent of in-hospital counselling. Other previously unknown problems detected during the home visit included hoarding of previously prescribed medication (35%) and reducing medication intake to minimise costs (21%). Conclusions: Management of prescribed medications among chronically ill patients recently discharged from acute hospital care is often sub-optimal. Assessment of medication management in the home provides an invaluable opportunity to detect and address problems likely to result in poorer health outcomes.