Vol 5, No 4 (2020)
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Published online: 2020-12-31

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Impact of readiness for discharge from the hospital on the implementation of the therapeutic plan

Agata Kosobucka1, Łukasz Pietrzykowski1, Piotr Michalski1, Michał Kasprzak2, Michał Siedlaczek1, Aldona Kubica1
Medical Research Journal 2020;5(4):256-264.


Introduction. Adherence to therapeutic recommendations regarding pharmacotherapy and lifestyle modification reduces the risk of complications in patients after myocardial infarction. The assessment of readiness for discharge allows to get knowledge about patient’s preparation for functioning at home. The aim of the study is to assess the relationship between the readiness for discharge of patients after myocardial infarction and adherence to pharmacotherapy based of the analysis of prescription filling.

Material and methods.
The study is a single-center, prospective, observational cohort clinical trial with a one-year follow-up period. The study population include 225 patients (26.7% women and 73.3% men) aged 30–91years (62.9 ± 11.9). The RHD-MIS (Readiness for Hospital Discharge after Myocardial Infarction Scale) was used to assess the readiness for discharge. Adherence to medication has been studied in relation to ACE inhibitors, P2Y12 receptor inhibitors and statins.

Patients with a high overall RHD MIS score compared to those with an average result were more likely to have any breaks in therapy, p = 0.01 (breaks < 30 days, p = 0.03 and breaks ≥ 30 days, p = 0.005) for either drug. Patients declaring that their disease is not serious have significantly lower adherence to P2Y12 receptor inhibitor (28 ± 27% vs 72 ± 38%, p = 0.047) and statins (36 ± 41% vs 76 ± 33% p = 0.024) in the 1st quarter after discharge and to statins (23 ± 18% vs 65 ± 32% p = 0.014) during whole one-year follow-up.

The readiness for discharge from the hospital assessed with the RHD-MIS does not clearly affect the implementation of the therapeutic plan in the long-term follow-up in patients after myocardial infarction. Data suggesting a negative impact of some aspects of readiness for discharge on adherence to treatment require further, in-depth research.

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  1. Nichols M, Townsend N, Scarborough P, et al. Cardiovascular disease in Europe: epidemiological update. Eur Heart J. 2013; 34(39): 3028–3034.
  2. Rasmussen JN, Chong A, Alter DA. Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction. JAMA. 2007; 297(2): 177–186.
  3. Kubica A, Grześk G, Sinkiewicz W, et al. Compliance, concordance, adherence w przewlekłej terapii. Folia Cardiologica Excerpta. 2010; 5(2): 54–57.
  4. Menzin J, Wygant G, Hauch O, et al. One-year costs of ischemic heart disease among patients with acute coronary syndromes: findings from a multi-employer claims database. Curr Med Res Opin. 2008; 24(2): 461–468.
  5. Simoni-Wastila L, Wei YJ, Qian J, et al. Association of chronic obstructive pulmonary disease maintenance medication adherence with all-cause hospitalization and spending in a Medicare population. Am J Geriatr Pharmacother. 2012; 10(3): 201–210.
  6. Naderi SH, Bestwick JP, Wald DS. Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376,162 patients. Am J Med. 2012; 125(9): 882–887.e1.
  7. Kubica A. Edukacja zdrowotna na tle wybranych czynników a skuteczność terapii antyagregacyjnej u pacjentów po zawale serca. Wyd. Nauk. Uniwersytetu Mikołaja Kopernika,Toruń- Bydgoszcz . 2012.
  8. Kubica A, Grześk G, Grąbczewska Z. Choroby układu sercowo- naczyniowego- wyzwanie dla promocji zdrowia. Cardiovasc Forum. 2006; 11: 44–47.
  9. Brunton SA. Improving medication adherence in chronic disease management. J Fam Pract. 2011; 60(4 Suppl Improving): S1–S8.
  10. Visser A, Deccache A, Bensing J. Patient education in Europe: united differences. Patient Education and Counseling. 2001; 44(1): 1–5.
  11. Kosobucka A, Michalski P, Pietrzykowski Ł, et al. Adherence to treatment assessed with the Adherence in Chronic Diseases Scale in patients after myocardial infarction. Patient Prefer Adherence. 2018; 12: 333–340.
  12. Kosobucka A, Kasprzak M, Michalski P, et al. Relation of the Readiness for Hospital Discharge after Myocardial Infarction Scale to socio-demographic and clinical factors. An observational study. Medical Research Journal. 2018; 3(1): 32–37.
  13. Kosobucka A, Michalski P, Pietrzykowski Ł, et al. The impact of readiness to discharge from hospital on adherence to treatment in patients after myocardial infarction. Cardiol J. 2020 [Epub ahead of print].
  14. Pietrzykowski Ł, Michalski P, Kosobucka A, et al. Medication adherence and its determinants in patients after myocardial infarction. Sci Rep. 2020; 10(1): 12028.
  15. Buszko K, Kosobucka A, Michalski P, et al. The readiness for hospital discharge of patients after acute myocardial infarction: a new self-reported questionnaire. Medical Research Journal. 2017; 2(1): 20–28.
  16. Ho PM, Lambert-Kerzner A, Carey EP, et al. Multifaceted intervention to improve medication adherence and secondary prevention measures after acute coronary syndrome hospital discharge: a randomized clinical trial. JAMA Intern Med. 2014; 174(2): 186–193.
  17. Bansilal S, Castellano JM, Garrido E, et al. Assessing the Impact of Medication Adherence on Long-Term Cardiovascular Outcomes. J Am Coll Cardiol. 2016; 68(8): 789–801.
  18. Ho PM, Spertus JA, Masoudi FA, et al. Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med. 2006; 166(17): 1842–1847.
  19. Simpson RJ. Challenges for improving medication adherence. JAMA. 2006; 296(21): 2614–2616.
  20. Hussain S, Jamal SZ, Qadir F. Medication Adherence In Post Myocardial Infarction Patients. J Ayub Med Coll Abbottabad. 2018; 30(4): 552–557.
  21. Lee YM, Kim RB, Lee HJ, et al. Relationships among medication adherence, lifestyle modification, and health-related quality of life in patients with acute myocardial infarction: a cross-sectional study. Health Qual Life Outcomes. 2018; 16(1): 100.
  22. Kubica A, Obońska K, Kasprzak M, et al. Prediction of high risk of non-adherence to antiplatelet treatment. Kardiol Pol. 2016; 74(1): 61–67.
  23. Spertus JA, Kettelkamp R, Vance C, et al. Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry. Circulation. 2006; 113(24): 2803–2809.
  24. Weiss ME, Costa LL, Yakusheva O, et al. Validation of patient and nurse short forms of the Readiness for Hospital Discharge Scale and their relationship to return to the hospital. Health Serv Res. 2014; 49(1): 304–317.
  25. Weiss ME, Piacentine LB, Lokken L, et al. Perceived readiness for hospital discharge in adult medical-surgical patients. Clin Nurse Spec. 2007; 21(1): 31–42.
  26. Michalski P, Kosobucka A, Pietrzykowski Ł, et al. Knowledge and learning preferences of patients with myocardial infarction. Medical Research Journal. 2017; 1(4): 120–124.
  27. Kubica A, Kochman W, Bogdan M, et al. The influence of undergone pecutaneous coronary interventions and earlier hospitalization with myocardial infarction on the level of knowledge and the effectiveness of health education in patients with myocardial infarction. Advances in Interventional Cardiology. 2009; 5: 25–30.
  28. Kubica A, Grześk G, Grąbczewska Z. Choroby układu sercowo- naczyniowego- wyzwanie dla promocji zdrowia. Cardiovasc Forum. 2006; 11: 44–47.
  29. Paterson B, Kieloch B, Gmiterek J. 'They never told us anything': postdischarge instruction for families of persons with brain injuries. Rehabil Nurs. 2001; 26(2): 48–53.
  30. Weiss ME, Yakusheva O, Bobay KL. Quality and cost analysis of nurse staffing, discharge preparation, and postdischarge utilization. Health Serv Res. 2011; 46(5): 1473–1494.
  31. Stewart K, Mc Namara KP, George J. Challenges in measuring medication adherence: experiences from a controlled trial. Int J Clin Pharm. 2014; 36(1): 15–19.
  32. Farmer KC. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Ther. 1999; 21(6): 1074–90; discussion 1073.
  33. Gierlotka M, Zdrojewski T, Wojtyniak B, et al. Incidence, treatment, in-hospital mortality and one-year outcomes of acute myocardial infarction in Poland in 2009-2012--nationwide AMI-PL database. Kardiol Pol. 2015; 73(3): 142–158.
  34. Kubica A, Sinkiewicz W, Szymański P, et al. Edukacja zdrowotna w chorobach układu krążenia — możliwości i zagrożenia. Folia Cardiol Excerpta. 2006; 2: 177–181.
  35. . A, Jafar S, Kumar G, et al. Cardiac Risk Factor Changes Through an Intensive Multifactorial Life Style Modification Program in CHD Patients: Results from a Two Year Follow Up. Journal of Biological Sciences. 2008; 8(2): 248–257.
  36. Kubica A, Pufal J, Moczulska B, et al. Skuteczność edukacji zdrowot-nej u osób hospitalizowanych w klinice kardiologii. Psychiatr Prakt Ogólnolek. 2005; 5: 61–68.
  37. Kubica A, Kasprzak M, Obońska K, et al. Impact of health education on adherence to clopidogrel and clinical effectiveness of antiplatelet treatment in patients after myocardial infarction. Medical Research Journal. 2016; 3(4): 154–159.
  38. Normington K, Goodwin S. A personalised approach to cardiac rehabilitation. Prof Nurse. 2000; 15(7): 432–436.
  39. Kubica A, Kasprzak M, Obońska K, et al. Discrepancies in assessment of adherence to antiplatelet treatment after myocardial infarction. Pharmacology. 2015; 95(1-2): 50–58.
  40. Gassner LA, Dunn S, Piller N. Patients' interpretation of the symptoms of myocardial infarction: implications for cardiac rehabilitation. Intensive Crit Care Nurs. 2002; 18(6): 342–354.
  41. Smith J, Liles C. Information needs before hospital discharge of myocardial infarction patients: a comparative, descriptive study. J Clin Nurs. 2007; 16(4): 662–671.
  42. Wiles R, Kinmonth A. Patients' understandings of heart attack: implications for prevention of recurrence. Patient Educ Couns. 2001; 44(2): 161–169.
  43. Crowley MJ, Zullig LL, Shah BR, et al. Medication non-adherence after myocardial infarction: an exploration of modifying factors. J Gen Intern Med. 2015; 30(1): 83–90.
  44. Fivecoat HC, Sayers SL, Riegel B, et al. Social support and self-care of patients with heart failure. Ann Behav Med. 2008; 35(1): 70–79.
  45. Wu JR, Chung M, Lennie TA, et al. Testing the psychometric properties of the Medication Adherence Scale in patients with heart failure. Heart Lung. 2008; 37(5): 334–343.
  46. Suzuki T, Shiga T, Omori H, et al. Adherence to medication and characteristics of Japanese patients with non-valvular atrial fibrillation. J Cardiol. 2017; 70(3): 238–243.
  47. Winter MP, von Lewinski D, Wallner M, et al. Incidence, predictors, and prognosis of premature discontinuation or switch of prasugrel or ticagrelor: the ATLANTIS - SWITCH study. Sci Rep. 2019; 9(1): 8194.
  48. Ko DT, Chiu M, Guo H, et al. Patterns of use of thienopyridine therapy after percutaneous coronary interventions with drug-eluting stents and bare-metal stents. Am Heart J. 2009; 158(4): 592–598.e1.
  49. Michalski P, Kosobucka A, Pietrzykowski Ł, et al. Effectiveness of therapeutic education in patients with myocardial infarction. Medical Research Journal. 2018; 2(3): 89–96.
  50. Michalski P, Kasprzak M, Siedlaczek M, et al. The impact of knowledge and effectiveness of educational intervention on readiness for hospital discharge and adherence to therapeutic recommendations in patients with acute coronary syndrome. Medical Research Journal. 2020.
  51. Pietrzykowski Ł, Michalski P, Kosobucka A, et al. Medication adherence and its determinants in patients after myocardial infarction. Sci Rep. 2020; 10(1): 12028.
  52. Kubica A, Adamski P, Bączkowska A, et al. The rationale for Multilevel EDucational and MOtivational intervention in patients after myocardial infarcTION (MEDMOTION) project is to support multicentre randomized clinical trial EvaLuating safety and EffiCacy of two TicagRelor-based de-escalation Ant. Medical Research Journal. 2020.
  53. Kubica A. Self-reported questionnaires for a comprehensive assessment of patients after acute coronary syndrome. Medical Research Journal. 2019; 4(2): 106–109.
  54. Kubica A, Gruchała M, Jaguszewski M, et al. Adherence to treatment — a pivotal issue in long-term treatment of patients with cardiovascular diseases. An expert standpoint. Medical Research Journal. 2018; 2(4): 123–127.