# Assessing Patient Understanding and Adherence to Preoperative Medication Advice Provided in Pre-Admission Clinic

## TL;DR

Many patients don't follow pre-surgery medication advice, often due to confusion or forgetfulness, leading to risks and cancellations.

## Contribution

The study identifies key factors influencing non-adherence to preoperative medication advice and suggests multimodal communication strategies to improve it.

## Key findings

- 41.7% of patients did not adhere to preoperative medication advice, with common reasons being forgetfulness and misunderstanding.
- Non-adherence was strongly linked to the number of medications and the time between clinic visits and surgery.
- Most non-adherent patients preferred a combination of verbal and written communication.

## Abstract

Background: Appropriate medication management before surgery is essential to minimise perioperative risk. Patient adherence to preoperative medication advice demonstrates considerable variability and is influenced by multiple interacting factors. This study assessed patient understanding and adherence to preoperative medication advice provided in the Pre-Admission Clinic (PAC) and identified factors contributing to non-adherence. Methods: A cross-sectional survey study was conducted over 12 weeks in 2022 at a tertiary hospital. Adult patients scheduled for elective surgery who received preoperative medication advice in PAC were surveyed on the day of surgery. Data collected included demographics, clinical characteristics, adherence, reasons for non-adherence, and communication preferences. Descriptive and inferential statistics were used for analysis. Results: Of 156 participants, 91 (58.3%) adhered to medication advice, while 65 (41.7%) did not. Common reasons for non-adherence included forgotten advice (35.4%), misunderstood advice (33.8%), and intentional deviation due to surgery (18.5%). Non-adherence rates were highest for NSAIDs (50.0%) and P2Y12 inhibitors (45.5%). Two surgeries were cancelled due to the delayed cessation of anticoagulants. Non-adherence was significantly associated with a greater number of medications requiring perioperative management (p = 0.004) and a longer duration between PAC and surgery (p = 0.010). Most non-adherent patients (64.7%) preferred a combination of verbal and written advice. Conclusions: A substantial proportion of patients were non-adherent to preoperative medication advice, often due to unclear communication or a lack of understanding of the clinical rationale for the advice. Multimodal strategies, including written or digital reinforcement of verbal advice, multidisciplinary collaboration, and patient-centred education, may improve adherence and reduce preventable cancellations. Future studies should evaluate the impact of these interventions.