About half of all patients hospitalized for heart conditions make mistakes with their medications within a month of hospital discharge, even if they receive follow-up guidance from a pharmacist, according to a study in the Annals of Internal Medicine.
Sunil Kripalani, lead author from Vanderbilt University Hospital in Nashville, and colleagues followed 851 patients who were hospitalized for heart failure or a heart attack at Vanderbilt University Hospital and Brigham and Women's Hospital in Boston. Half of the patients were given two follow-up appointments to consult with a pharmacist, who reviewed patients' medications and offered them continuing instruction. These patients also received tools, such as a pillbox or medication chart. The other cohort received no unique post-discharge counseling.
After one month, 432—or 51%—patients made at least one potentially harmful or harmful error in taking their medication, including discontinuing the medication too early, continuing it for too long, taking the wrong dose, or missing a dose entirely. Twenty-three percent of these mistakes were considered serious and 1.8% life-threatening. Furthermore, there was no difference in error rates for those who received additional support from a pharmacist and those who did not.
Researches admit that not all patients in the intervention group received two follow-up calls. Additionally, it is unclear whether the findings would apply to patients with non-cardiac conditions.
Factors influencing adherence
Kevin Boesen, director of the Medication Management Center at the University of Arizona College of Pharmacy in Tucson, Ariz., says the study "highlights the challenge for the transition from hospital to home." He stresses the importance for patients to regularly meet with their pharmacist and primary care doctor after hospital discharge or when they fill a prescription elsewhere in order to avoid confusion. Keeping a list of drugs and using one pharmacy for all prescriptions can help physicians and pharmacists better manage their patients' medications.
According to Adam Auerback, director of inpatient cardiac services at North Shore University Hospital, economic reasons can affect adherence. A handful of patients split pills or skip doses to cut costs. Prescribing cheaper generic drugs could reduce that problem.
Furthermore, patients with a strong social support system make fewer errors, Auerback says. Those without such support "are the people we are trying to reach" (Seaman, Reuters, 7/4; Mann, HealthDay, 7/3).