Hospitalization is often associated with changes in patients’ pharmacotherapy. Medication reconciliation aims, among other, to inform patients about these changes and consequently empower them to participate actively in their pharmacotherapy. The main aim of this Master’s thesis was to investigate whether medication reconciliation improves patients’ primary adherence to medications initiated upon discharge from the University Clinic Golnik.
A total of 414 medical patients, hospitalized at the University Clinic Golnik, were included either in the intervention (225/414; 54,3%) or control group (189/414; 45,7%). Patients in the intervention group received medication reconciliation at hospital admission and discharge, including pharmacist-led counseling, while patients in the control group received standard clinical care. All data were obtained from medical records, pharmacy dispensing records, and follow-up telephone interviews with patients, conducted 30 days after discharge. Patients were judged to be primary adherent with a medication, if this was either provided upon hospital discharge or dispensed by the pharmacy not later than the day following hospital discharge.
Upon discharge, a total of 787 newly initiated medications were issued, with a median of two per patient. Patients were primarily adherent with 71,0% of all newly initiated medications (559/787). Patients in the intervention group were primarily adherent to a higher proportion of medications (316/391; 80,8%) compared to those in the control group (243/396; 61,4%). Patients in the intervention group also obtained a higher proportion of newly initiated medications on the day of discharge (270/391; 69,0%) than patients in the control group (189/396; 47,0%). Furthermore, a significantly higher proportion of patients in the intervention group were fully primarily adherent (178/225; 79,1%) compared with those in the control group (100/189; 52,9%; p < 0,001). Patients in the intervention group were over three times more likely to be primarily adherent to newly initiated medications than those in the control group (OR = 3,428; 95% CI 2,156–5,450; p < 0,001). Primary adherence was also associated with younger age and a smaller number of newly initiated medications. Medications whose initiation was intentional and documented were 33 times more likely to be dispensed on the day of discharge or the following day (OR = 33,776; 95% CI 9,709–117,506; p < 0,001), while those with intentional but undocumented initiation were 15 times more likely (OR = 14,886; 95% CI 4,201–52,755; p < 0,001) compared with medications whose initiation was unintentional. Primary medication adherence was nearly four times higher when medications were initiated for a short-term treatment period (OR = 3,780; 95% CI 1,362–10,488; p = 0,011). Differences in primary medication adherence were also observed among different ATC groups of newly initiated medications (p = 0,005). The lowest adherence rates were observed for medications for respiratory diseases and for antidepressants, sedatives, and antipsychotics, while the highest adherence was found for antidiabetic agents, antithrombotic agents, anti-infectives for systemic use, and analgesics.
This study confirmed the positive impact of medication reconciliation at hospital admission and discharge, coupled with patient's counseling, on patients’ primary adherence to newly initiated medications upon discharge, further supporting the need for the routine implementation of this service in clinical practice.
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