Economic impact of Patient's Own Medication use during hospitalisation: a multicentre pre-post implementation study

Implementation of a pragmatic emergency department patients' own medications (POM) procedure to improve medication safety: An interrupted time series

BACKGROUND

Patients' Own Medications (POMs) are useful to inform clinical decision-making, best possible medication history documentation, and ensure timely medication administration. A procedure was developed for managing POMs specifically in the emergency department (ED) and short stay unit. This study evaluated the impact of this procedure on process and patient safety outcomes.

METHODS

An interrupted time-series was undertaken in a metropolitan ED/short stay unit between November 2017 and September 2021. Pre-implementation and during each of four post-implementation time-periods, data were collected at unannounced times on approximately 100 patients taking medications prior to presentation. Endpoints included proportion of patients with POMs stored in green POMs bags, in standardised locations, and proportion who self-medicated without nurses knowing.

RESULTS

Following procedure implementation, POMs were stored in standardised locations for 45.9 % of patients. Proportion of patients with POMs stored in green bags increased from 6.9 % to 48.2 % (difference 41.3 %, p < 0.001). Patient self-administration without nurses' knowledge declined from 10.3 % to 2.3 % (difference 8.0 %, p = 0.015). POMs were infrequently left in ED/short stay unit after discharge.

CONCLUSIONS

The procedure has standardised POMs storage, but room for further improvement remains. Although POMs were not locked away and were readily available to clinicians, patient self-medication without nurses' knowledge declined.

Economic Analysis of Patient's Own Medication, Unit-Use and Ward Stock Utilization: Results of the First Pilot Study

BACKGROUND

Medication wastage is causing a cost burden to the healthcare system that is worth millions of dollars. An economic and ecological friendly intervention such as using a patient's own medications (POM) has proven to reduce wastage and save the cost spent by the hospital. The potential benefits of using POM in inpatient settings have yet to be explored in a country with universal health coverage. This study aimed to pilot test the POM intervention in an adult ward setting and to perform the economic analysis of using POM and ward stock during hospitalization.

METHODS

A prospective cross-sectional observational study was conducted among the patients admitted to the medical and surgical wards in a public hospital located in Brunei Darussalam between February 2022 and April 2022. Hospitalized adults above 18 years old with regular medications with a minimum length of stay of 48 h and a maximum length of stay of 21 days were included in the study. These eligible patients were divided into a POM group and a non-POM group. The economic analysis of using POM was performed by calculating the direct cost per unit of medication used during admission (from unit-use, ward stock and POM) and comparing the cost spent for both groups. Expired ward stock deemed as medication wastage was determined. Medical research ethics were approved, and all participating patients had given their written informed consent before enrolling in this study.

RESULTS

A total of 112 patients aged 63.2 ± 15.8 years participated in this study. The average cost of medication supplied by the inpatient pharmacy for the non-POM group was USD 21.60 ± 34.20 per patient, whereas, for the POM group, it was approximately USD 13.00 ± 18.30 per patient, with a mean difference of USD 8.60 ± 5.17 per patient (95% CI: -3.95, 27.47, p ≥ 0.05). The use of POM minimized 54.03% (USD 625.04) of the total cost spent by the hospital for the POM group within the period of the study.

CONCLUSION

The pilot study showed that the supplied medication cost per patient was not significantly different between the POM and non-POM groups. Nevertheless, the utilization of POM during hospitalization is capable of reducing at least 50% of the total cost spent on inpatient medications by the hospital. The use of POM during hospitalization also helped in reducing the total time spent on the medication process per patient.

The effect of Patient's Own Medication use on patient's self-reported medication knowledge during hospitalisation: a pre-post intervention study

Background

Improving patient’s medication knowledge and consequently medication use is essential for optimal treatment outcomes. As patient knowledge about medication is currently suboptimal, interventions to optimise medication knowledge are necessary. Implementation of Patient’s Own Medication (POM) in which patients bring their outpatient medication to the hospital, and nurses administer these during admission, may increase medication knowledge. The aim of this study is to explore the impact of POM use on self-reported medication knowledge of hospitalised patients compared to standard care. Patient’s sense of medication safety, attitude to the provision of information, and to inpatient medication use were studied in both standard care and during POM use too.

Method

In this nationwide intervention study perceived medication knowledge was assessed with a questionnaire pre and post implementing POM use. The questionnaire assessed perceived medication knowledge at admission and discharge, medication safety during hospitalisation, the provision of information during hospitalisation and at discharge, and inpatient medication use during hospitalisation. Patients’ answers were categorised into positive and negative/neutral. The proportion of patients with adequate medication knowledge, in the standard care and POM use group at hospital admission and discharge, were calculated and compared with adjustment for potential confounders.

Results

Among the 731 patients (393 received standard care and 338 POM) who completed the questionnaire (80.2%), POM use seemed to be positively associated with self-reported knowledge on how to use medication at discharge (adjusted OR: 3.22 [95% CI 2.01–5.16]). However, for the other two knowledge related statements POM use was not associated. Medication knowledge at admission was the most important variable associated with perceived medication knowledge at discharge. The majority perceived POM use to be safer (52.9% of standard care patients versus 74.0% POM users; P <  0.01), POM users knew better which medicines they still used during hospitalisation (85.8% versus 92.3% resp.; P = 0.01), and most patients preferred POM use regardless of having experienced it (68.2% versus 82.2% resp.; P <  0.01).

Conclusion

POM use positively affects patient’s medication knowledge about how to use medication and patients’ perception of medication safety. With POM use more patients have a positive attitude towards the provision of information. The majority of patients prefer POM use. In conclusion, POM use seems a valuable intervention and requires further investigation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07752-6.

Patients’ views on Self-administration of Medication during hospitalisation: a mixed-methods study

Background:

Inpatient Self-administration of Medication (SAM) increases patient involvement in medication management and may increase medication safety. Its implementation is impeded. Successful and sustainable implementation of SAM strongly depends on patients’ willingness to participate. This study aimed to identify and quantify patients’ views on SAM, related (dis)advantages and prerequisites, patient’s willingness to engage in SAM schemes, and their preferences in medication management during hospitalisation.

Methods:

A mixed-methods study was conducted among hospitalised adult patients in four Dutch hospitals during December 2018 and March 2019. Semi-structured one-to-one interviews were performed to identify patients’ views on SAM. Interview transcripts were subjected to thematic-content analysis. These outcomes were used to construct a questionnaire about patient’s willingness to engage in SAM schemes, their preferences for inpatient medication management and level of agreement with statements about SAM’s (dis)advantages and prerequisites of SAM. Data were descriptively analysed.

Results:

Nineteen hospitalised patients [mean (standard deviation; SD) age 61.0 (13.4) years old; 52.6% male] were interviewed. Most patients had a positive view on SAM, but some doubted the necessity to change standard care. Also, patients expressed concerns about medication safety. Prerequisites for SAM implementation were identified. These covered four main themes: information provision, accessible and safe storage, assurance of safety, and clear responsibilities. A total of 234 patients [mean (SD), age 65.3 (13.5) years; 54.7% male] participated in the questionnaire. Although 50.0% of the patients were willing to self-administer medication, patients were ambivalent as only 36.5% preferred SAM over nurse-led administration.

Conclusion:

The majority of patients were positive about SAM. Although half of the patients were willing to perform SAM, most patients did not prefer SAM over standard care. This ambivalent attitude may be overcome when the stated prerequisites are met and patients experience SAM in clinical practice. Based on patients’ views, it can be concluded that implementation of SAM seems possible.

Plain Language Summary

Research to identify patients’ views on Self-administration of Medication during hospitalisation Background: Patient involvement is desired by patients. Nevertheless, currently healthcare providers take over patient’s medication management when hospitalised. Capable patients administering their own medication during hospitalisation, known as ‘Self-administration of Medication’ (SAM) is one possible way to increase patient involvement in hospital care and to improve medication safety. Understanding patients’ views on SAM, before its actual practice, could help to successfully implement it. In this research, we aimed to identify and measure patients’ views on SAM, (dis)advantages of and requirements for SAM stated by patients, patients’ willingness to self-administrate medication, patients’ preferences in medication management during hospitalisation. Methods: Our study consisted of two parts and was conducted among hospitalised adult patients in four Dutch hospitals during December 2018 and March 2019. First, patients were interviewed to identify patients’ views on SAM, requirements for SAM. Second, the outcomes of these interviews were used to construct a questionnaire aiming to identify patient’s willingness to self-administrate, preferences for self- or nurse-led medication administration, level of agreement with statements about SAM’s (dis)advantages and requirements. Results: Nineteen hospitalised patients were interviewed. Most patients had a positive view on SAM, some doubted the necessity to change nurse-led medication administration. Patients mentioned many advantages of SAM, such as increased patient empowerment and contribution to sustainability. Some patients had concerns about medication safety, for example, risking omissions or double administrations. In total, 234 patients completed the questionnaire. Half (50%) of the patients were willing to self-administer medication. However, only 37% of patients preferred SAM over nurse-led medication administration which indicates that the majority of patients were hesitant to actually self-administer medication. The most important requirements for SAM by patients were, ‘I want to be informed before my hospitalisation that I have to bring my own medication’ (80% agreed) and ‘Healthcare professionals must assess per patient whether the patient is able to manage and use his or her own medication’ (74% agreed). Conclusion: Most patients mentioned many advantages and had positive views on SAM. Although half of the patients were willing to perform SAM, most patients did not prefer SAM over nurse-led medication administration. This reservation may be overcome when the stated requirements are met and patients experience SAM when admitted to hospital.

The Effect of Self-Administration of Medication During Hospitalization on Patient's Self-Efficacy and Medication Adherence After Discharge

PURPOSE

The effect of self-administration of medication (SAM), in which capable hospitalized patients administer medication themselves on medication self-efficacy is inconclusive. The aim of this study was to evaluate the effect of SAM on medication self-efficacy, adherence and patient satisfaction.

PATIENTS AND METHODS

A prospective pre-post intervention study on the orthopedic ward of the Sint Maartenskliniek (Nijmegen) was conducted from January 2020 to July 2021. All adults admitted to this ward were eligible for participation. The primary outcome was the level of medication self-efficacy measured by the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) one week after discharge. Secondary outcomes were SEAMS-score three months after hospitalization, medication adherence measured by the Medication Adherence Rating Scale (MARS) one week and three months after hospitalization and patient satisfaction expressed on a five-point Likert scale in patients who experienced SAM. The differences in median SEAMS-scores and non-adherence pre- versus post-implementation of SAM were statistically analyzed. Patients' agreement regarding satisfaction with SAM was calculated as proportion per Likert scale answer.

RESULTS

Of the 197 patients participating in the study, 96 were included pre- and 101 post-implementation of SAM. Median SEAMS-scores one week after discharge were 35 [IQR 31-38] and 34 [IQR 30-36] pre- and post-intervention respectively (p = 0.08). There was no difference in the proportion of non-adherent patients at one week and three months after discharge pre- and post-intervention, 52.4%, 53.2%, 57.9% and 64.4% respectively. Of the patients that experienced SAM 32% agreed and 49% strongly agreed that they would like to self-manage medication again during a future hospitalization.

CONCLUSION

In this orthopedic population with high medication self-efficacy scores at discharge, SAM did not affect patients' medication self-efficacy nor medication adherence after hospitalization. Most patients preferred SAM. Additional studies should focus on the effect of SAM in other patient populations.

Comparing the cost, glycaemic control and medication adherence of utilizing patients' own medicines (POMs) versus usual dispensing among diabetic patients in an outpatient setting

BACKGROUND

Millions worth of unused drugs particularly those indicated for chronic diseases such as diabetes were returned and disposed leading to substantial wastage. Use of patients' own medications (POMs) in the inpatient setting has reduced wastage and saved cost. The impact of utilizing POMs in the outpatient setting has hitherto not been determined.

PURPOSE

This study aims to compare the cost, medication adherence and glycaemic control of utilizing POMs versus usual dispensing.

METHODS

Prospective randomized controlled study was conducted among diabetic patients that required monthly medication refill in the Outpatient Pharmacy in 2017. Patients who consented were equally divided into POMs and control groups. Both groups brought excess medications from home at week-0 and week-12. Patients in the POMs group brought excess medications monthly and sufficient amount of drugs were added until the next refill date. Drugs were dispensed as usual in the control group. Total cost consisting of the cost of drugs, staff and building was calculated. Glycosylated haemoglobin (HbA1c) was measured at baseline and week-12. Adherence was measured based on pill counting.

RESULTS

Thirty patients aged 56.77 ± 14.67 years with 13.37 ± 7.36 years of diabetes participated. Baseline characteristics were similar between the groups. POMs minimized the total cost by 38.96% which translated to a cost saving of USD 42.76 ± 6.98, significantly different versus USD 0.02 ± 0.52 in the control group, p = 0.025. Mean HbA1c reduced significantly (-0.79%, p = 0.016) in the POMs group but not significant in the control group (-0.11%, p = 0.740). Medication adherence improved significantly in both groups at week-12 (p < 0.010). Nevertheless, patients in the POMs group were more adherent, 87.20% vs. 66.32%, p = 0.034.

CONCLUSION

Utilizing POMs resulted in cost saving, improved adherence and better glycaemic control. Use of POMs should be practiced in the outpatient pharmacy to reduce wastage and cost.