A Qualitative Descriptive Study of Admitted Homeless Patients' Perceptions of Prescribed Medications

Abstract

Background: Homeless individuals experience a higher rate of emergency department visits, increased hospital lengths of stay, and increased healthcare costs compared to the general population. Medication non-adherence is one factor that has been linked to these outcomes. Although barriers to medication adherence in the homeless population have been described, patient perceptions of medications as a barrier are not well understood. Objective: To describe the perceptions, attitudes, and beliefs about prescribed medications held by hospitalized patients who are homeless. Methods: A qualitative descriptive study design using semi-structured interviews was conducted from February 27 to May 16, 2017. Interviews were conducted during patients’ admissions to the General Internal Medicine service of a tertiary care, inner city hospital. Interviews were audio-recorded and transcribed. Data were analyzed using conventional qualitative content analysis to generate data-driven codes and themes. Results: Twelve interviews were conducted (median age 48.5 years). Two-thirds of patients were living in a shelter and 11 (91.7%) patients had a mental illness. Patients were prescribed a median of four medications at the time of hospital admission and self-reported not taking prescribed medication doses on average 6.8 days in the 30 days preceding hospital stay. Four themes were identified: 1) patients acquired a new appreciation of medications during hospitalization; 2) patients perceived medications as necessary for maintaining health; 3) patients had an interest in receiving medication education; and 4) patients expressed concerns regarding medication adverse effects. Conclusion: During hospital admission, homeless patients have positive perceptions about the necessity of their medications but have concerns of medication adverse effects. Interventions to improve adherence may be successful if directed towards addressing treatment-related concerns. Future studies could explore the impact of pharmacist education on medication perceptions and adherence following hospital discharge.