Vol 5, No 4 (2020)
Original article
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.

Abstract

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.

Results.
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.

Conclusion.
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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