Uncovering a multitude of sins: medication management in the home post acute hospitalisation among the chronically ill

Background: Sub‐optimal use of prescribed medication is often associated with unplanned hospitalisation among the chronically ill. Aims: To examine the extent of sub‐optimal use of prescribed medication in a ‘high risk’ patient cohort recently discharged from acute hospital care. Methods: Chronically ill patients discharged from acute hospital care ( n =342) were studied. At one week post discharge a home visit was performed by a nurse and a pharmacist during which medication management (including compliance and medication—related knowledge) was assessed. Results: During the majority of home visits at least one medication‐related problem was detected: approximately half of the cohort subject to a ‘reliable’ pill‐count were found to be mal‐compliant and almost all demonstrated inadequate medication‐related knowledge. Mal‐compliance was correlated with ≥ five prescribed medications (Odds ratio [OR] 2.6: p <0.002). Comparatively, lower medication‐related knowledge was correlated with age >75 years (OR 2.2: p <0.001), exacerbation of a pre‐existing chronic illness (OR 2.7: p =0.044) and six years formal education (OR 1.9: p ≥0.004). Neither were modulated by extent of in‐hospital counselling. Other previously unknown problems detected during the home visit included hoarding of previously prescribed medication (35%) and reducing medication intake to minimise costs (21%). Conclusions: Management of prescribed medications among chronically ill patients recently discharged from acute hospital care is often sub‐optimal. Assessment of medication management in the home provides an invaluable opportunity to detect and address problems likely to result in poorer health outcomes.