Research continues to show that patients do not remember - or understand - everything they are told when they are discharged from medical facilities.  An earlier Ix Blog post on health literacy and patient recall discussed findings such as 14% of patients being unaware of the fact that their physician had prescribed a new medication for them.

A more recent article in the Annals of Emergency Medicine found a strong tendency for patients to overestimate their understanding of emergency department (ED) care and discharge instructions.  Patients had more difficulty understanding post-ED discharge care instructions than information about the diagnosis and cause of their illness, ED care, or return instructions.

This research finding suggests that asking patients whether or not they understand medical instructions is not an adequate way to measure comprehension.  Although handwritten or printed discharge instructions are considered a best practice, this should not be the only method of communicating discharge instructions to patients.  Asking patients to explain information or instructions in their own words may be a better strategy for assessing patient understanding and providing clues about where to focus further discussion and explanation.

A recent University of California study reports a striking increase in fatal medication errors (FMEs) over the last 22 years.  The study examined accidental deaths occurring at home, but also included deaths occurring away from home.  The deaths were further categorized into those involving alcohol and/or street drugs and those not involving alcohol and/or street drugs.

The most striking increase in FMEs was with those that occurred at home, especially those involving alcohol and/or street drugs (a 3,196% increase).  FMEs at home, not involving alcohol and/or street drugs increased by 564%.   FMEs that occurred away from home involving alcohol and/or street drugs increased by 555%.  Finally, FMEs away from home, but not involving alcohol and/or street drugs increased by 5%.

Shifts in health care have resulted in reduced professional oversight and increased patient responsibility for monitoring medication use.  Information therapy prescriptions can play a critical role in complementing medication prescriptions.  If consumers are expected to manage increasingly complex - and potentially dangerous - drug regimes, they need access to tailored information to help them do so safely.

This month’s issue of Mayo Clinic Proceedings has two interesting studies and an insightful editorial (”Medication Literacy Is a 2-Way Street”) that highlight why information therapy (Ix) is so valuable at the end of a hospital stay.

Kripalani et al found that, for patients with limited literacy skills discharged for acute coronary syndrome, 22% had not filled their prescriptions and 21% had difficulty understanding the purpose of the drugs prescribed to them. Maniaci et al studied well-educated patients discharged from an internal medicine hospital ward with at least one new medication prescribed. This study found that, 1-2 weeks post-discharge, 14% were unaware of being given a new medicine. Much worse were the percentages of patients that could recall the name (64%), dosage (56%) or purpose (64%) of the drugs.

It’s clear that providers are not doing an adequate job of ensuring that patients are leaving the hospital with the information they need to manage their recovery effectively. But it’s largely not due clinician error; rather, it’s that little has been done to integrate that information transfer into the care delivery process–especially at critical moments in care such as the discharge process.

That’s why Ix is so critical to ensuring that discharged patients can recover to better health and reduce the chances of being readmitted. Innovative Ix leaders from around the country will be sharing best practices on how to change care delivery to meet patients’ information needs at the 7th Annual Conference. Please join us June 12-13 in Washington, DC to get engaged in this critical element of patient-centered care delivery redesign.