Understanding Medication Challenges Among Older Adults After Hospital Discharge

1UCSF Medical Center, San Francisco, CA
2San Francisco Veterans Administration Medical Center, San Francisco, CA

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97555

Background:

Older adults have a 19% risk of 30–day readmission, and medication safety plays an important role in reducing this risk. We conducted telephone–based interviews as part of a qualitative study to better understand the needs of older adults around medication management following hospital discharge.

Methods:

The study population included patients discharged from the general internal medicine service at an academic teaching hospital. Inclusion criteria were age =65 years, English–speaking, and discharged home ([pm]home services) with at least five medications. Patients in hospice were excluded. If a patient preferred or was cognitively/hearing impaired, the primary caregiver was interviewed. All interviews were conducted within 2–4 weeks of discharge, audiotaped, and transcribed. We used semistructured, open–ended questions asking if problems with medications arose since leaving the hospital, what services and resources patients had at time of discharge and then at home, and what help they needed during those periods. Analysis was from a grounded theory approach. For participants who answered “no problems,” we used common scenarios based on the medical literature as prompts. Concurrent with our study, as part of a system–wide quality improvement program, hospital discharge nurses attempted to reach all participants with a standard postdischarge telephone call that included two medication–related questions: “Did you fill your prescriptions?” and “Did you understand your medication instructions?”

Results:

We interviewed nine participants (patients = 7, caregivers = 2), with 20 interviews pending. Among the nine interviewed, three participants initially denied having any medication problems, but with prompting endorsed side effects (n = 2) and difficulty paying for medication (n = 1). Other difficulties that arose included medication adherence and medication titration. Eight participants named “family” as the main source of assistance. Regarding needs at discharge, a predominant theme was lack of communication (n = 5): “I don’t think anyone has any time to discuss with me before I left.” Four participants denied needing any additional help at discharge with reasons being family support (n = 2) or confidence in self–ability (n = 2). The latter group, however, qualified their response by saying they did “not yet” need assistance. Of note, six of the nine participants received the standard postdischarge telephone call and none of these calls revealed any medication problems.

Conclusions:

Medication problems are common, and and brief standardized postdischarge phone calls may not identify medication problems the standard postdischarge phone calls seem not to find them. The predominant themes of family and lack of communication suggest focal points for future design of discharge programs. Even participants who denied needing assistance still qualified their response with a “yet,” suggesting needs are a moving target.

To cite this abstract:

Liu D, Chi H, Steinman M, Rennke S. Understanding Medication Challenges Among Older Adults After Hospital Discharge. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97555. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/understanding-medication-challenges-among-older-adults-after-hospital-discharge/. Accessed May 23, 2019.

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