Patients understanding their medications and taking them as instructed are important parts of improving the care and outcomes of heart attack patients, as well as potentially reducing avoidable readmissions, according to research presented at the ACC Quality Summit in New Orleans.
Reducing readmissions in particular is a top goal for many hospitals and health systems, as 30-day readmission rates are now used to determine federal reimbursement, with financial penalties levied to underperformers.
A new quality improvement plan, developed at Olathe Medical Center in Olathe, Kansas, and initiated as part of the American College of Cardiology's Patient Navigator Program: Focus MI, showed promising results and shed light on how to approach the issue.
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The study group considered the patient perspective on the hospital discharge and follow-up experience when developing solutions.
A heart attack is typically an unexpected event, which can leave patients overwhelmed by new medications, clinicians and other additions to their healthcare upon release from the hospital. When patients are discharged from the hospital, hospital staff educate them about their medications, but many patients have difficulty understanding and following these instructions.
Patients often feel there's been little preparation for their care plan post-discharge, the researchers said. Another complaint is that follow-up care isn't well-established, with limited communication from providers after hospitalization. Medication instructions may also be difficult to understand.
In April 2018, an interdisciplinary team at Olathe Medical Center, including an assigned bedside registered nurse, cardiology nurse navigator, floor pharmacists and outpatient cardiac rehab staff, established and implemented a number of medication education communication process.
After a patient is admitted, an assigned bedside nurse reviews any new medications with the patient, family member or caregiver, including what they are used for and any side effects of that particular medication; this can be done through pre-made patient medication cards.
Once the discharge medications have been prescribed by the physician, the cardiology nurse navigator asks the patient to write out medication information on a visual aid form called a medication log. This include the names of their discharge medications, what the medications are used for, dose, frequency and what time of day the medications should be taken.
Next, the floor pharmacist educates the patient in greater depth about their medications, explaining potential side effects and any drug interactions, what to do if a dose is missed and offering any other needed instructions.
After discharge, the patient will receive a transition of care phone call within 48 hours from a care coordinator or the nurse navigator. This call includes medication teach back, which requires the patient to read back from memory or read from their prescription bottles the name and usage of their medication.
At the patient's first outpatient cardiac rehab appointment, they are asked to place a check mark by their current medications from a list of common cardiac medications. This helps ensure they are knowledgeable about their medicine.
Using the Hospital Consumer Assessment of Healthcare Providers and Systems survey -- a satisfaction survey required by the Centers for Medicare and Medicaid Services for all U.S. hospitals -- the study group found the hospital's HCAHPS scores for medication understanding increased by 10 percent between quarter one and quarter two in 2018 following program implementation.
Plus, before plan implementation, the 2018 quarter one unadjusted readmission rate was 8.2 percent. Since implementation, the quarter two rate went down to 3.4 percent and quarter three was 3.6 percent.
Patients who aren't properly educated about their medications can cost the health system money. Drug adherence isn't just important for the person taking the medicine. It's also critical for the financial well-being of the healthcare system generally, with some estimates placing the cost of nonadherence as high as $300 billion annually.
A 2018 Couch study found Almost half of those with health conditions said that they skip their medication sometimes, despite knowing its benefits, while more than a quarter are unsure what to do if they experience side-effects.