The Effect of Self-Administration of Medication During Hospitalization on Patient’s Self-Efficacy and Medication Adherence After Discharge

Purpose: The effect of self-administration of medication (SAM), in which capable hospitalized patients administer medication themselves on medication self-efficacy is inconclusive. The aim of this study was to evaluate the effect of SAM on medication self-efficacy, adherence and patient satisfaction.

Patients and Methods: A prospective pre-post intervention study on the orthopedic ward of the Sint Maartenskliniek (Nijmegen) was conducted from January 2020 to July 2021. All adults admitted to this ward were eligible for participation. The primary outcome was the level of medication self-efficacy measured by the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) one week after discharge. Secondary outcomes were SEAMS-score three months after hospitalization, medication adherence measured by the Medication Adherence Rating Scale (MARS) one week and three months after hospitalization and patient satisfaction expressed on a five-point Likert scale in patients who experienced SAM. The differences in median SEAMS-scores and non-adherence pre-versus post-implementation of SAM were statistically analyzed. Patients’ agreement regarding satisfaction with SAM was calculated as proportion per Likert scale answer.

Results: Of the 197 patients participating in the study, 96 were included pre-and 101 post-implementation of SAM. Median SEAMS-scores one week after discharge were 35 [IQR 31–38] and 34 [IQR 30–36] pre-and post-intervention respectively (p = 0.08). There was no difference in the proportion of non-adherent patients at one week and three months after discharge pre-and post-intervention, 52.4%, 53.2%, 57.9% and 64.4% respectively. Of the patients that experienced SAM 32% agreed and 49% strongly agreed that they would like to self-manage medication again during a future hospitalization.

Conclusion: In this orthopedic population with high medication self-efficacy scores at discharge, SAM did not affect patients’ medication self-efficacy nor medication adherence after hospitalization. Most patients preferred SAM. Additional studies should focus on the effect of SAM in other patient populations.