title: Improving Patient's Primary Medication Adherence: The Value of Pharmaceutical Counseling.
abstract: Quality of transitions of care is one of the first concerns in patient safety. Redesigning the discharge process to incorporate clinical pharmacy activities could reduce the incidence of postdischarge adverse events by improving medication adherence. The present study investigated the value of pharmacist counseling sessions on primary medication adherence after hospital discharge.This study was conducted in a 1844-bed hospital in France. It was divided in an observational period and an interventional period of 3 months each. In both periods, ward-based clinical pharmacists performed medication reconciliation and inpatient follow-up. In interventional period, initial counseling and discharge counseling sessions were added to pharmaceutical care. The primary medication adherence was assessed by calling community pharmacists 7 days after patient discharge.We compared the measure of adherence between the patients from the observational period (n = 201) and the interventional period (n = 193). The rate of patients who were adherent increased from 51.0% to 66.7% between both periods (P < 0.01). When discharge counseling was performed (n = 78), this rate rose to 79.7% (P < 0.001). The multivariate regression performed on data from both periods showed that age of at least 78 years old, and 3 or less new medications on discharge order were predictive factors of adherence. New medications ordered at discharge represented 42.0% (n = 1018/2426) of all medications on discharge order. The rate of unfilled new medications decreased from 50.2% in the observational period to 32.5% in the interventional period (P < 10). However, patients included in the observational period were not significantly more often readmitted or visited the emergency department than the patients who experienced discharge counseling during the interventional period (45.3% vs. 46.2%; P = 0.89).This study highlights that discharge counseling sessions are essential to improve outpatients' primary medication adherence. We identified predictive factors of primary nonadherence in order to target the most eligible patients for discharge counseling sessions. Moreover, implementation of discharge counseling could be facilitated by using Health Information Technology to adapt human resources and select patients at risk of nonadherence.
authors.affiliation: From the Department of Pharmacy, Nîmes University Hospital, Nîmes, France (GLB, FD, CRM, FA, JMK); Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, EA2415, University Institute of Clinical Research, Montpellier University, Montpellier, France (GLB, CRM, CC, JMK); Department of Biostatistics, Epidemiology, Clinical Research and Health Economics, Nîmes University Hospital, Nîmes, France (SB, CC); Department of General Medicine, Nîmes University Hospital, Nîmes, France (VR); and Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes, France (AS).
authors.forename: Géraldine
authors.initials: G
authors.lastname: Leguelinel-Blache
authors.forename: Florent
authors.initials: F
authors.lastname: Dubois
authors.forename: Sophie
authors.initials: S
authors.lastname: Bouvet
authors.forename: Clarisse
authors.initials: C
authors.lastname: Roux-Marson
authors.forename: Fabrice
authors.initials: F
authors.lastname: Arnaud
authors.forename: Christel
authors.initials: C
authors.lastname: Castelli
authors.forename: Valérie
authors.initials: V
authors.lastname: Ray
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Kinowski
authors.forename: Albert
authors.initials: A
authors.lastname: Sotto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003376:Counseling; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D055118:Medication Adherence; D059065:Medication Reconciliation; D008875:Middle Aged; D010351:Patient Discharge; D010595:Pharmacists; D011446:Prospective Studies