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Research project finds communications problems between patients and health care providers in Regina

It's not uncommon for patients to be confused about what medications they should take at home when discharged from hospital.

Sometimes drugs are started, stopped or the dose changed while patients are hospitalized, but that information isn't always clearly conveyed to them by healthcare providers.

A research project led by Cheyanne Boehm found another surprising reason for the confusion - an increasing number of Regina patients had poor literacy skills and English wasn't their first language.

"Our province is expanding and, obviously, demographics are changing and that's something that they found is a barrier," she said.

To fulfil her residency requirements as a pharmacist, she had to complete a research project.

"When I was a student, prior to becoming a pharmacist, I worked in a community pharmacy during one of my rotations and I noticed that a lot of patients, when they were discharged, weren't clear on what they were taking - they were overwhelmed with information with the hospital stay and just the stress for whatever they were admitted for," she said. "They often couldn't recall their medication changes, why they were started, what to take - they were really quite confused. That prompted me to wonder what actually goes on in the hospital? What information are patients being provided? Is there something we could be doing differently?" To answer that question, she led a research project called Patient Medication Education at Discharge: A Multidisciplinary, Team-Based Approach.

Because patients are educated about medications by various health-care professionals, Boehm held a multidisciplinary focus group including a community pharmacist, cardiology pharmacist, pharmacy manager, cardiology nurse, nurse manager, nurse educator and social worker.

The project, which began in June 2012 and ended last month, focused on the medication discharge education process for patients with atrial fibrillation - an irregular heart rhythm - at the Cardiac Surveillance Unit (CSU) at the Regina General Hospital.

"There are some things that we're doing really well, but I think there's always room for improvement," Boehm said. "It's been shown in the literature that about 50 per cent of patients are being discharged from hospitals without receiving education."

One of her objectives was to find out how CSU staff educated patients about medication before discharge. Although patients receive booklets and medication sheets, she found significant communication gaps between inpatient and outpatient care providers. "Patients are typically sent with discharge plans that are faxed to the family physicians and community pharmacists, but sometimes they aren't faxed to the community pharmacy or they're not receiving enough information on what the patient was admitted for or why they're being started on medications," she said. "They could have provided better education had they had that information."

Her research found that health-care professionals are currently providing discharge medication education, but that the documentation of this education is not always located in a consistent place within the chart, and may not be communicated between wards as well.

Boehm proposed a number of changes, including all CSU providers be responsible for providing patient education, a clinical pharmacist be more accessible to nurses and patients, and health-care providers use a standardized form to show what patients were told.

To ensure patients who struggle to understand how to take their medication, Boehm suggested a patientfriendly video explaining atrial fibrillation and how drugs treat it. She also recommended the unit use translators.

"I'm super-excited to see that some of the changes are being implemented," Boehm said. "Sometimes you find that research kind of sits there and things don't change."

The project received a student award of excellence at the Regina Qu'Appelle Health Region's Research Showcase held recently in Regina. Cheyanne Boehm received her Bachelor of Science in Pharmacy degree from the U of S in 2012.

By: Pamela Cowan, Regina Leader-Post