Improving compliance behaviour after discharge: the role of a hospital pharmacist

Abstract

This thesis demonstrates that compliance is problematic in the elderly population studied and requires intervention if treatment failure is to be avoided. Non-compliance risk level was measured by use of a questionnaire and was found to be different for each of the subjects interviewed. Four different risk factors were identified as problems for over 50% of the subjects interviewed. Lack of understanding of regime, general dissatisfaction with prescribed treatment, poor provision of information from health professionals, and polypharmacy. However, no two subjects had identical combinations of problems and therefore generalisation into categories was not possible. Correlation between the categories was low. The most commonly required interventions were provision of individually tailored verbal information or standardised written information on discharge, attempting to simplify the medication regime and finding solutions to various physical problems. All elderly hospital inpatients should be offered these interventions as routine services. In particular, it is essential that hospital pharmacists provide medication information to patients and attempt to achieve concordance as the study suggests that this is not a priority to hospital doctors. Polypharmacy should be avoided by regular prescription review, however, polypharmacy cannot always be avoided for patients with multiple disease states. Hospital pharmacists have a vital role in solving compliance. However, primary care must therefore be involved in any decision to implement interventions. General practitioners and community pharmacists have the greatest opportunity amongst health professionals of being able to effect change in compliance behaviour. Many changes to the boundary divides between primary and secondary care must be bridged by means of cross-sectoral posts in order to ensure that compliance and concordance are achieved.