Elsevier

Mayo Clinic Proceedings

Volume 80, Issue 8, August 2005, Pages 991-994
Mayo Clinic Proceedings

Original Article
Patients' Understanding of Their Treatment Plans and Diagnosis at Discharge

https://doi.org/10.4065/80.8.991Get rights and content

OBJECTIVE

To ascertain whether patients at discharge from a municipal teaching hospital knew their discharge diagnoses, treatment plan (names and purpose of their medications), and common side effects of prescribed medications.

PATIENTS AND METHODS

From July to October 1999, we surveyed 47 consecutive patients at discharge from the medical service of a municipal teaching hospital in New York City (Brooklyn, NY). Patients were asked to state either the trade or the generic name(s) of their medication(s), their purpose, and the major side effect(s), as well as their discharge diagnoses. Patients were excluded if they were not oriented to person, place, and time, were unaware of the circumstances surrounding their admission to the hospital, and/or did not speak or understand English.

RESULTS

Of the 47 patients surveyed, 4 were excluded. Of the remaining 43 patients, 12 (27.9%) were able to list all their medications, 16 (37.2%) were able to recount the purpose of all their medications, 6 (14.0%) were able to state the common side effect(s) of all their medications, and 18 (41.9%) were able to state their diagnosis or diagnoses. The mean number of medications prescribed at discharge was 3.89.

CONCLUSIONS

Less than half of our study patients were able to list their diagnoses, the name(s) of their medication(s), their purpose, or the major side effect(s). Lacking awareness of these factors affects a patient's ability to comply fully with discharge treatment plans. Whether lack of communication between physician and patient is actually the cause of patient unawareness of discharge instructions or if this even affects patient outcome requires further study.

Section snippets

Patients and Methods

From July to October 1999, we surveyed 47 consecutive patients at discharge from the medical service of a public hospital in Brooklyn, NY, to determine whether they could state either the trade or the generic name(s) of their medication(s), the purpose of their medications, and the major side effect(s) associated with each medication. Patients were also asked to recall their diagnosis or diagnoses. Patients were permitted to supplement recall from memory with written notes that they may have

Results

Of the 47 patients surveyed at discharge, a total of 4 were excluded, 3 because of a language barrier (non-English speaking) and 1 because of being disoriented and judged incapable of properly answering our questions. Demographic characteristics of the study population are given in TABLE 1, TABLE 2, TABLE 3.

Of the 43 remaining patients, 12 (27.9%) were able to list all their discharge medications, 16 (37.2%) were able to recount the purpose of all their medications, 6 (14.0%) were able to

Discussion

Most of our patients (72.1%) were not able to list the names of all their medications. However, more patients could state the purpose of all their medications than could state the names. Commonly seen and expected side effects of medications were known by the least percentage of patients of all the other measures we analyzed. Those able to recount their diagnosis or diagnoses were the highest percentage of patients (41.9%).

We used a binary approach of patients recalling all their medications or

Conclusions

All methods that enhance the patient's understanding of his or her discharge treatment plan focus on one central aspect—proper communication. Although not all patients are noncompliant because of poor communication, this is probably the leading cause of noncompliance. Communication involves many aspects, including language (speaking to the patient in terms he or she can understand), practicality (giving the patient a regimen that he or she can follow without much disruption to daily life), and

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    Implementing pen and paper by bedside, a printed leaflet prompting patient questions, and updating whiteboards all received the majority support (> 60%) from patients that these interventions would have helped with knowledge retention. Our findings echo those demonstrated in the literature of multiple previous studies that recurrently showed poor patient understanding of medical care.2,14,17–19 For example, using similar chart review and verification, Horwitz et al. reported that only 59.6% of sampled patients had complete understanding of the reason for their hospital admission, 32.2% knew only symptoms leading to admission, and 8.2% did not have any understanding of the reason for their admission.1

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