Evaluation of hospital discharge prescriptions: are we favoring access to medications?

Abstract

Objectives: To assess access within the public health system to medications prescribed at hospital discharge for patients admitted to the emergency unit of a high-complexity teaching hospital, as well as to analyze the role of the pharmacist in discharge counseling. Methods: This was a retrospective cross-sectional study that evaluated 1,068 electronic discharge prescriptions issued in 2023. Medications were classified according to the components of pharmaceutical assistance and compared with municipal lists of essential medicines. Items were considered inaccessible if they were absent from the lists, subject to incompatible restrictions, prescribed by brand name, or, in the case of the specialized component of pharmaceutical assistance, lacked the required Request Form. Dispensing by the day hospital and the occurrence of pharmacist-led discharge counseling were also evaluated. Results: A total of 4,229 medications were analyzed. Of these, 45.45% were inaccessible, mainly due to absence from municipal lists (81.22%), incompatible restrictions (9.52%), or lack of the required form (7.96%). Inaccessibility was higher for “as needed” or one-time-use medications, while in the specialized component, it predominated among medications for continuous use. There was wide variability in access among patients’ municipalities of origin, with no clear correlation to population size or per capita GDP. The day hospital supplied only 2.9% of the inaccessible items. Pharmacist counseling was documented in 12 discharges (1.1%), although 23% of patients were on polypharmacy. Conclusion: The study reveals a high rate of inaccessibility to medications at hospital discharge, highlighting the need for improvements in access and for strengthening the pharmacist’s role in both the pharmacy and therapeutics committee and in clinical care.