The findings are concerning to physicians because failure of patients to follow treatment plans or understand the requirements after leaving their care could result in readmission to the hospital with compounding health problems and additional health care costs.
Patients are responsible to follow treatment plans, but communication from physicians and health care teams needs to improve to meet the patient's needs, say the study's authors.
The study in the August 2005 issue of Mayo Clinic Proceedings by Amgad Makaryus, M.D., of the Department of Medicine, North Shore University Hospital in Manhasset, N.Y., and Eli Friedman, M.D., of the Department of Medicine, State University of New York, Health Science Center in Brooklyn, N.Y., set out to determine whether patients at the time of discharge from a municipal teaching hospital knew their discharge diagnoses, treatment plan, and common side effects of prescribed medications. They studied 43 patients from July to October 1999.
The authors report that 72 percent of the patients were not able to list the names of all of their medications, however, more could state the purpose of their medications. And about 58 percent of the patients were unable to recount their diagnosis or diagnoses.
"All methods that enhance the patient's understanding of his or her discharge treatment plan focus on one central aspect -- proper communication," says Dr. Friedman. "Although not all patients are noncompliant because of poor communication, this is probably the leading cause of noncompliance."
Dr. Friedman notes that communication involves many aspects, including language (speaking to the patient in terms the patient understands), practicality (giving the patient a regimen that can be followed without much disruption to daily life) and time (spending reasonable time counseling the patient and ensuring that the patient actually comprehends the instructions).
"Without willingness of the health care team to devote time to communication, the careful and effective treatment that was delivered in the hospital may not continue after discharge because of patient noncompliance," says Dr. Friedman.
However, the authors recommend that further study take place to fully ascertain the effects of the problem their study has identified. "Whether lack of communication between physician and patient is actually the cause of patient unawareness of discharge instructions or if this even affects patient outcome requires further study," says Dr. Friedman.
In an editorial in the same issue of Mayo Clinic Proceedings, Edward Rosenow III, M.D., of Mayo Clinic's Division of Pulmonary and Critical Care Medicine, concurs and offers some suggestions.
"I collectively refer to the issues contributing to misunderstanding and medication noncompliance as the sixth vital sign because in many ways they are as important as the well-known four vital signs and the new fifth vital sign of pain," says Dr. Rosenow. "An impaired sixth vital sign can result in setbacks and readmissions to the hospital as easily as the other five signs." Dr. Rosenow offers 11 ideas for improving aftercare:
- Educating patients and the public about the importance of compliance should begin in primary school.
- With a new diagnosis, the patient and family could be given information, written at their education level, about the disease or condition. Good online sources such as medlineplus.gov or MayoClinic.com offer further, reliable information.
- A plan to stratify the patient's likelihood of compliance or noncompliance should be considered. He lists considerations such as age, education, command of English, the number of medications being taken and other medical conditions.
- Medical centers should convene continuous improvement committees to establish a uniform approach to the problem at the medical center.
- Health educators at medical centers need to be part of the health team. They also need to be multilingual.
- Knowledge of the cultural mores of most ethnic groups must be part of the context of the patient's outpatient and inpatient dismissal plan.
- Physicians should consider directly observed therapy and can involve highly motivated educated volunteers to assist.
- A discharge summary written directly for the hospitalized patient should be in a language the patient can understand.
- Focus groups are effective for some patients with a chronic illness.
- A video compact disk with a description of each drug the patient is taking could be provided and updated at each visit. It would show what the drug looks like and explain its purposes and benefits, and would contain a reminder of the importance of compliance.
- Better prescription-container labeling -- larger containers are needed to allow for a larger label in big print.
A peer-review journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 75 years and has a circulation of 130,000 nationally and internationally. Copies of the articles are available online at www.mayoclinicproceedings.com.
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