Many patients are unable to properly comply with their doctor's orders upon being discharged from the hospital. Alicia Arbaje, a director with the Johns Hopkins School of Medicine in Baltimore, explained that these transitions from the hospital are often more challenging for older individuals with multiple health conditions. Others say that patient compliance is largely linked to their patient activation level (PAM).
An individual's PAM is essentially their level of knowledge and understanding of their own medical condition(s). It is often measured by the patient's ability to comprehend and properly “self-manage illnesses or problems”. Those with low activation levels may need better quality instruction and more proactive follow-up after being discharged.
Recent Case: Patient Admission
A patient in the hospital was determined to have Clostridium difficile (C. diff) as well as an infection in her foot. Various medications were prescribed by the physician attending to her. These medications included oral vancomycin and dicloxacillin. At the pharmacy, the patient found that she was unable to afford the vancomycin that was ordered to treat her C. diff.
Several weeks later her condition worsened and she returned to the hospital where a procedure to remove a large portion of her colon was needed. She later filed a claim of medical malpractice accusing the physician of negligence. She asserted that she was inadequately informed of the importance of the medication and that the doctor should not have prescribed her a product that she could likely not afford.
Recent Case: Potential Negligence
The defense denied the allegations of negligence and stated the patient was negligent in failing to take the medication as instructed. The claim stated that the doctor should have been aware that his underinsured patient would be unable to afford the product. After a lengthy period of litigation, the case was ultimately dismissed. If proper follow-up regarding adherence to the treatment had been conducted the problem could have been avoided.
Data From Recent Study
A Brigham & Women's Hospital research study involved 851 patients that were being discharged from the hospital. The patients were split into two groups. One group received follow-up from a pharmacist while the others did not. Those who did not receive a personal contact after the discharge were simply provided a written listing of the instructions. They determined that the intervention by the pharmacist had a very minimal effect on whether there were medication-related errors. Another finding revealed that the vast majority of incidents where patients have medication errors after release are preventable.
Best Practices for Reducing Risk
- Patients should be educated regarding their treatment after discharge before their day of release
- All questions the patient has should be written down and then addressed individually
- The information should be provided in varying formats such as photo, video, type, etc.
- Physicians should ask patients to “show them” that they are aware of how to administer medications by demonstrating
- Patients may be asked to repeat (verbally) the instructions to test comprehension
- Any written instruction should be at no more than a sixth-grade reading level to allow for better comprehension