What Do Patients with Long-Term Conditions Disclose About Medication Adherence During and After Hospital Discharge? A Qualitative Study at an Internal Medicines Ward in Norway.

Abstract

Purpose: To explore how patients' life circumstances, perceptions, lived experiences and behaviors may influence medication adherence in the social context surrounding hospital discharge.

Patients and methods: Ten patients aged 48-89 years were included at a hospital ward close to the presumed day of discharge, observed during healthcare personnel (HCP) encounters and interviewed 1-2 weeks after discharge. Medication adherence was reconstructed through medication reconciliation and by comparing observations of hospital encounters and discharge information with patients' post-discharge accounts of medication use. Data were analyzed using content analysis to identify themes across participants and narratives to explore individual experiences.

Results: The analysis revealed the themes 1) "beliefs about medicines" and 2) "self-efficacy". We found that patient beliefs about medicines were often not fully explored during clinical encounters, however according to the patients, these factors play a key role in explaining adherence challenges. Although all patients stated that they intended to take their medications as instructed by the HCPs at the hospital, more than half of them had consciously or unconsciously changed the medication treatment compared to the discharge summary. The patient narratives illustrate multiple factors contributing to non-adherence after hospital discharge.

Conclusion: This study suggests that important influences on medication adherence may remain insufficiently explored during routine discharge encounters. Our findings indicate that discharge processes could be strengthened by incorporating more structured and patient-centred conversations that invite patients to discuss their beliefs, concerns, and anticipated challenges with medication management. This could include asking open-ended questions about how patients understand their treatment, how they expect to manage it in daily life, and what uncertainties or barriers they foresee. Such conversations might help identify barriers to adherence and better support patients' self-management after discharge.