ROCHESTER, Minn. -- Researchers report in the current issue of MayoClinic Proceedings that more than one-half of their study patients wereunable to list their medications, diagnoses, treatment plan (names andpurposes of medications) and common side effects of prescribedmedications.
The findings are concerning to physicians because failure ofpatients to follow treatment plans or understand the requirements afterleaving their care could result in readmission to the hospital withcompounding health problems and additional health care costs.
Patients are responsible to follow treatment plans, butcommunication from physicians and health care teams needs to improve tomeet the patient's needs, say the study's authors.
The study in the August 2005 issue of Mayo Clinic Proceedings by AmgadMakaryus, M.D., of the Department of Medicine, North Shore UniversityHospital in Manhasset, N.Y., and Eli Friedman, M.D., of the Departmentof Medicine, State University of New York, Health Science Center inBrooklyn, N.Y., set out to determine whether patients at the time ofdischarge from a municipal teaching hospital knew their dischargediagnoses, treatment plan, and common side effects of prescribedmedications. They studied 43 patients from July to October 1999.
The authors report that 72 percent of the patients were not able tolist the names of all of their medications, however, more could statethe purpose of their medications. And about 58 percent of the patientswere unable to recount their diagnosis or diagnoses.
"All methods that enhance the patient's understanding of his or herdischarge treatment plan focus on one central aspect -- propercommunication," says Dr. Friedman. "Although not all patients arenoncompliant because of poor communication, this is probably theleading cause of noncompliance."
Dr. Friedman notes that communication involves many aspects, includinglanguage (speaking to the patient in terms the patient understands),practicality (giving the patient a regimen that can be followed withoutmuch disruption to daily life) and time (spending reasonable timecounseling the patient and ensuring that the patient actuallycomprehends the instructions).
"Without willingness of the health care team to devote time tocommunication, the careful and effective treatment that was deliveredin the hospital may not continue after discharge because of patientnoncompliance," says Dr. Friedman.
However, the authors recommend that further study take place to fullyascertain the effects of the problem their study has identified."Whether lack of communication between physician and patient isactually the cause of patient unawareness of discharge instructions orif 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., ofMayo Clinic's Division of Pulmonary and Critical Care Medicine, concurs and offers some suggestions.
"I collectively refer to the issues contributing to misunderstandingand medication noncompliance as the sixth vital sign because in manyways they are as important as the well-known four vital signs and thenew fifth vital sign of pain," says Dr. Rosenow. "An impaired sixthvital sign can result in setbacks and readmissions to the hospital aseasily as the other five signs." Dr. Rosenow offers 11 ideas forimproving aftercare:
A peer-review journal, Mayo ClinicProceedings publishes original articles and reviews dealing withclinical and laboratory medicine, clinical research, basic scienceresearch and clinical epidemiology. Mayo Clinic Proceedings ispublished monthly by Mayo Foundation for Medical Education and Researchas part of its commitment to the medical education of physicians. Thejournal has been published for more than 75 years and has a circulationof 130,000 nationally and internationally. Copies of the articles areavailable online at www.mayoclinicproceedings.com.
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