Discharge instruction improves cardiac patients’ medication knowledge, compliance
Discharge instruction has led to improvements in knowledge, compliance and comprehension on medication among adult cardiac service patients, according to a study presented at the Singapore Prevention & Cardiac Rehabilitation Symposium (SPCRS) 2017. Furthermore, it appears that discharge planning confers a clearer and more comprehensive medication instruction.
The authors conducted a descriptive research to assess the significant difference in comprehension and compliance on discharge instructions among cardiac patients (n=24) in the Philippine Heart Center, considering total enumeration of adult social service patients diagnosed with cardiac disease.
Participants were administered survey questionnaires used by Clarke including Discharge Instruction Evaluation. Pre- and post-test knowledge scores were compared using dependent t-test. Logistic regression analysis was performed to analyse factors associated with compliance.
There was a marked increase in knowledge and compliance on patients’ medication with discharge instruction (p=0.001). Participants demonstrated greater comprehension with antihypertensive drugs, anticoagulants, cardiac glycosides, diuretics and cholesterol-lowering medications. [SPCRS 2017, abstract N-35]
According to the authors, the results stressed the fact that compliance is not only about dutifully taking the medication but about taking or missing the medication for the right reasons.
“Effective discharge planning is very crucial to care continuity. Compliance with medical recommendation is a complex challenge for every discharged patient as far as patient safety is concerned,” researchers said.
“Failure to conform with instruction can lead to worse medical repercussions, hence, excellent planning and good follow-up can improve patient’s health, reduce readmissions and decrease healthcare costs,” they added.
In 2014, Albrecht and colleagues conducted a prospective cohort study involving 450 adults (aged ≥65 years) admitted to medical and surgical units of a tertiary care facility. They found that noncomprehension of discharge instructions among older adults was prevalent, multifactorial and varied by domain. [J Gen Intern Med 2014;29:1491-8]
Findings showed that noncomprehension prevalence was 5 percent for follow-up appointments, 27 percent for medications, 48 percent for exercise and 50 percent for diet recommendations. Age correlated with noncomprehension of medication (odds ratio [OR], 1.07; 95 percent CI, 1.04 to 1.12) and follow-up appointment (OR, 1.08; 1.00 to 1.17) instructions.
An association existed between male sex and noncomprehension of diet instructions (OR, 1.91; 1.10 to 3.31). Social isolation was associated with noncomprehension of exercise instructions (OR, 9.42; 1.50 to 59.11), and depression correlated with noncompliance with medication (OR, 2.29; 1.02 to 5.10) and diet instructions (OR, 3.30; 1.24 to 8.83).
Simplifying discharge materials is critical to ensure patient comprehension of discharge instructions, according to Alberti and colleague in a literature review. [J Am Assoc Nurse Pract 2013;25:186-94]