Mostly perceptions of the client informs their willingness (or lack of it) to filling up their medications. Some feel the medications make them feel worse, some feel they are ok and do not need refill while others are either simply nonchalant or forgetful.

Involving the pharmacist in client care is very important and such engagement should be done while the client is still on admission. The pharmacist should take time to educate the client during counseling not just at the point of discharge. Also, the relatives of the client should be well educated as to the importance of the medications. Finally, know that the client is the best person responsible for his/her health and should be made to be aware in firm terms so they take their health serious. Good refill adherence is a source of concern to many.

I am interested to know the amount of medication that is given to the patient when they are discharged. This ranges from 0 and and a new prescription is issued or up to 2 weeks when a new medication is started that cannot be obtained outside the hospital.

The involvement of pharmacists and ignoring reimbursement for a second it is v important that patients understand the need for their medicines and we should make it easy for patients to obtain them.

Dear Anu,

You touched one of the important barriers amongst the Geriatric population, especially in the GCC region it is very true that the Geriatrics often non comply with the Rx medications, and at times is very difficult to convince them , even the finest counsellor /consultant will find hard in their work.

Regards

All of the above are true; it also depends on the healthcare system. Some systems may or may not allow hospitals to give patients meds on discharge. this can influence the continuity. Also, sometimes (often!) the medicines in hospitals may not be the ones preferred by outpatient reimbursers, so changing meds by the physician caring for the patient after discharge may lead to problems. And, of course price/copays may be an issue in some systems (USA comes to mind).

Hi, after my span of almost 15 years in hospital pharmacy settings, I have come across  a number of possible reasons why patients do NOT have their discharge prescriptions filled from hospital after a stay in hospital and reasons why they may delay or not fill prescriptions from their community pharmacies (particularly after a hospital stay):

A/ Looking specifically at why patients may not have their hospital discharge medication dispensed: Patients have been known to not fill discharge meds for the following reasons: 1. Lack of education/ counseling on the importance of those meds; 2. time issues to just wanting to get home after a hospital stay and not wanting to wait extra time for discharge meds to be dispensed; 3. Number of days of medications issued via discharge varies in each hospital. Some hospitals dispense between 5 days up to a week's worth of medications and the patient then still needs to obtain further supplies via their community pharmacies. Some prefer to just obtain their whole supply of meds from their community pharmacies. 4. Some hospitals do not even supply the full list of the meds that the patient is currently on. For example, some hospitals in Australia will only supply the 'newly prescribed medication' that the patient has had during the recent stay in hospital and will not supply their regular medications. This becomes confusing for some patients as some may think that the other medications that have not been supplied, may not be as important or may be perceived as not needed in future. 

B/ Looking specifically at why patients may delay non-filling of prescription medication from their community pharmacies after a hospital stay: 1. issues of non-adherence; 2. Lack of time; 3. Cognitive impairment issues; 4. Lack of education/counseling by the health care practitioner regarding the importance of each medication for their continued health; 5. Money issues and cannot afford the cost for the full list of monthly prescription medications (One big concern: Some patients may try to decide which medications are perceived to be more important for their health and therefore only have some medications filled at any given time!)

Of course, the above lists are not limited to these points...

1. Cost: Many health cover providers will only pay for medications prescribed and used  during the admission (episode-of-care meds) and not ongoing or discharge drugs which are borne by the patient.

2. Weaknesses in the discharge system: A hospital pharmacy that pro-actively identifies patients due for discharge and schedules them for discharge counseling , provision of discharge meds or paper prescriptions greatly minimises this issue.

3. Inadequate patient information: Most of the verbal instructions and information provided is quickly forgotten if not backed by written discharge summaries and consumer medicine information (CMI) leaflets

4. Complexity of treatment: The larger the number of drugs the greater the likelihood of omission by the patient. Printed discharge summaries can minimise this as can flagging of patients on, say more than 5 drugs, for more focused discharge preparation by the pharmacy.

Lack of transition of care with community providers is a key reason. There is discharge planning often for a patient to their first psychiatrist visit post-discharge, yet, individuals are handed prescriptions to walk out without any certainty that they will actually be taken to a pharmacy  filled. More specialty pharmacist providers in psychiatry working with hospital case managers will help to address/alleviate this.  

Hello Cherie,

You have detailed the elaborate reasons for non-filling /delayed medication filling upon discharge, its been true that in almost all settings pharmacy visit by the patient comes at last (after laboratory,radiology,medical records etc.,) , it is natural that patients looses the patience when they reach the pharmacy windows.

In India , it is mainly due to lack of awareness, education and financial problem.