Evaluating Preoperative Medication Management: Focusing on Guideline Consistency and Patient Adherence, in A Tertiary Teaching Hospital
نویسندگان
1 Department of Pharmacotherapy, School of Pharmacy, Baqiyatallah University of Medical Sciences (BMSU), Tehran, Iran
2 Trauma Research Center, Faculty of Medicine, Baqiyatallah University of Medical Sciences (BMSU), Tehran, Iran
3 Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
4 Department of Pharmacotherapy, School of Pharmacy, Baqiyatallah University of Medical Sciences (BMSU), Tehran, Iran
doi
10.22034/ircmj.2026.524108.2165چکیده
Background and Objectives: More than half of pre-operative patients are chronically using at least one medication. Irrational pre-operative medication management leads to poor surgical outcomes, severe adverse reactions, and financial strain. This issue results from practitioner knowledge gaps and patient non-adherence. This study assesses how well a preoperative evaluation clinic’s physician recommendations align with clinical guidelines, besides evaluating patient adherence and influencing factors. Methods: This 6-month prospective study involved patients attending preoperative evaluation, considering more than 50 medication classes. The preoperative preparation form was evaluated for guideline consistency, and patients were asked regarding adherence to instructions. The pattern of consistency among each medication class was reported based on the UpToDate 2024. Moreover, factors affecting patients' adherence were investigated using a regression model. Results: Across 4190 medication recommendations for 862 patients, 61.26% were consistent with the guideline. Systemic corticosteroids (85.71%), gastrointestinal medications (80.07%), pulmonary medications (79.41%), thyroid medications (79.19%), psychiatric medications (74.07%), antihyperlipidemic agents (64.52%), and antidiabetics (63.24%) showed the highest guideline consistency, while, herbal medicines (20.00%), digoxin (25.00%), women’s hormonal medications (32.14%), diuretics (32.65%), anticoagulants (36.13%), antiplatelets (37.12%), NSAIDs (42.30%), and cardiovascular medications (54.22%) showed the lowest. 42% of patients were non-adherent, with age, sex, and days from clinic visit to hospitalization independently associated with patients' adherence. Conclusion: Considering in-service training for physicians on medication classes with poor guideline consistency, and implementing strategies to improve patient adherence, including targeted education, minimization of the interval between clinic visits, and hospitalization, seems necessary.
