Effective spoken and written communication of information about medicine to patients is crucial to the success of treatments. The effectiveness and safety of medicines cannot be maximized unless patients understand their role in the medicine-taking process. However, we generally communicate this information badly. Great effort and much time and money are devoted to the front end of developing medicines, but at the end of that process, when the medicine is actually handed over to patients, much is left to chance.
Hospital discharge offers a good opportunity for exploring how to communicate with patients to support the best use of their medicines. Two articles in this issue of Mayo Clinic Proceedings examine what happens when people are discharged from the hospital with new medicines.1, 2 Both throw into sharp relief the inadequacies of support systems for patients’ use of medicines at home, the medicines on which the success of much of modern health care is based.Kripalani et al1 followed up patients after hospital stays for acute coronary syndrome. They found that 22% had not filled their prescriptions and that 21% had some difficulty understanding the purpose of their medicines. In their patient population, literacy skills were limited. The second article by Maniaci et al2 featured a group of relatively well-educated patients given at least 1 new medicine while in hospital. When telephoned at home 1 to 2 weeks later, 14% were not aware they had been given a new medicine, and 36% did not know the name of the medicine or its purpose. As the authors rightly point out, success of outpatient treatment could hinge on patients’ understanding of their new medications. Knowing the name and purpose of a medicine is clearly central to being able to use it appropriately.
When information is given orally, much will be forgotten, and so patients need back-up documents to which they can refer at home. However, we know from studies in the United States and the United Kingdom that written information, such as labels and leaflets, do not currently meet patients’ needs.
Even if patients do receive usable spoken and written information, it could be argued that this information is still not sufficient. Once patients return home with their medicines (whether from the hospital or the physician’s office), both passive and active methods of communication must be available. Maniaci et al2 found that 32% of patients did not know whom they would ask if they had any questions about their medicines. Such “after-sales service” is routine in many sectors but not in medicine. We know that 50% of people using long-term medicines do not take them as prescribed.13
Follow-up is crucial for patients taking medicines at home, especially in the first few months. Such continuing engagement with patients after discharge or consultation needs to be considered, given that patients are often under stress and are likely to be less receptive to information when in hospital, particularly when they have just been told they have a serious illness that requires lifelong treatment.
This article includes statistics that show the severity of a lack of health literacy and pharmaceutical literacy. One of the most interesting things I pulled from here was the time period of when doctors give patients information about their medicine. As discussed, typically patients receive information and instructions about their medication in a brief manor after hospital discharge or at the end of a visit. However, patients may be experiencing information overload and therefore it may not be the most appropriate time to discuss medication. Alternatively, a phone check up days later which makes sure the patient understands their medication is a great way to avoid information overload at once. Also, clearly communicating the role of the pharmacist and how essential they are for patients who have questions about their medication is extremely vital.