For many participants, the reality of needing to take life-saving medication became apparent on their return home when they were confronted with the seriousness of the situation and the need to develop new daily medication routines. Many were grateful they were on sick leave or had time postdischarge to establish a routine, including being mindful of when medications needed to be taken and if they needed to be taken with meals or not.

And generally, I get up at the same time each day. Having said that, I am on sick leave at the moment. So that will take time and breakfast will change when I go back to work. But that’s down the track management. (P1)

For participants, especially those without prior experience with taking medication, remembering to administer doses, manage prescriptions and medication supply, and follow-up appointments with GPs while balancing prior commitments with family or work was an additional burden.

I’m just a really busy person. I work full-time and then I’ve got two kids. So, by having to throw medication in on that…I guess it’s like when you’re a new person to start taking medication…you’ve got to take the medication seriously. Like it’s not the first thing that’s on my mind which is not good. I need to change that. (P7)

Several participants reported they continued to lack understanding of their medication regimen, which was apparent when engaging with other health professionals such as dentists or rehabilitation therapists.

I even went to the dentist, and they said: ‘what are you on, we need to update your records’, and I didn’t even know. (P9)

I was just at Cardio Rehab [CRC]…and they asked me if I was on a beta-blocker, and I actually didn’t know what a beta-blocker was. I was, like, not sure! (P7)

Nine participants were recruited through the CRC at the JHH and reported increased accessibility and reinforcement of medication information through the clinic. Participation in the CRC provided participants with an opportunity for further engagement with specialists in cardiology and ask questions or raise concerns related to medications or management of their CVD.

…I was going to have a chat with one of the guys at the pharmacy, but I thought I’m at rehab [CRC] today, I’ll chat with them [the nurses] about the cholesterol medication I’m on. (P6)

Many participants relied on others to help manage their medications and adhere to their schedule, be that family members, carers or community pharmacists. While this was most evident in the weeks following discharge, others reported an ongoing reliance on family members or carers. As such, some participants acknowledged they had less opportunity to engage with community pharmacists for ongoing education, information or intervention if necessary.

My son sort of gets them out and gives them to me, and I just take them as I’m supposed to. I’m a bit foggy at the moment, but he’s looking after it. I’ll have to get more involved very shortly. (P15)

Because, say I say to my wife: ‘I’m too sick to get my tablets today, can you pick them up for me?’ So, if someone else goes and picks up your tablets for you, you don’t have any interaction with the pharmacist. (P5)

Many participants stated that their experience with pharmacist-led medication management services was limited to medication supply and prescription management, predominantly delivered in a community setting.

So, you know, I guess their role is pretty broad. But personally, I use them for prescriptions and information around that and that’s probably about it. (P12)

Sort of nothing really. Just when it comes to medication-wise. Like that’s the only time I sort of have anything to do with pharmacists, it’s when I’ve gotta pick up medication. (P14)

Participants readily identified the importance of community pharmacies managing their prescriptions and medications, including the use of dose administration aids (DAAs).

So obviously looking at things of whether Webster-paks or blister packs [medication compliance packaging]—pre-made medications—that sort of thing as well I think is really important. (P1)

However, some participants acknowledged that by relying on an external source there was the potential for error or oversight if they were not familiar with changes to their medications.

I gave my prescriptions actually to the pharmacist. You don’t have to think about sitting at the table and dividing them all up and hoping that they’re not all wrong…which has happened a couple of times. I’ve gone a couple of weeks without realising I wasn’t taking one particular [medication]. (P18)

Participants who followed through with an appointment to see their GP on discharge indicated the benefit of gaining further understanding of their recent hospitalisation and medication changes, including accessing new prescriptions.

I was told to go to my GP a week after which I did yesterday…she reinforced what [medications] they had sent me home with. (P11)

Overall, participants reported a wide range of challenges adhering to a medication regimen on discharge. Many participants were not supplied with sufficient medication quantities on discharge to see them through to their follow-up GP appointment, who were often required to wait several weeks.

…because my GP is booked out that far ahead, I’m looking at two to three weeks. When I rang up to say that I need an appointment to arrange some medications after I had a heart attack, they had to put me on an emergency waiting list, and even then, it took them seven days to get me in. (P3)

Participants were reportedly confronted with the concept of taking multiple medications, highlighting their embarrassment and the stigma associated with medication use. Some participants were reluctant to seek pharmacist-led medication management services, such as DAAs, due to its perceived association with advanced age.

…going into the pharmacy and just slapping them [the prescriptions] down on the counter, it’s just going to feel like I’m a walking medication taker! Once I get over the initial embarrassment…I’m actually going to be calling them and saying, ‘I need to fill my medication’. (P7)

And for me, personally, I still consider myself still fairly young, and I think this [DAA] is an old person’s thing. So, getting your head around it all, you know, it’s a little new. (P2)

Many participants commented on the benefit of accessing a community pharmacist for medication-related information and health advice prior to escalating any concerns to their GP.

I wouldn’t go and pick up a multivitamin or something without talking to the chemist [pharmacist]: ‘this is what I take. Could there be any interactions?’ (P12)

Because sometimes it’s hard to get into see your GP. And sometimes it’s not necessary to see your GP. I feel that [the community pharmacist] is the ‘first port-of-call’; unless you’re really, really sick. (P6)

Conversations with a community pharmacist on discharge home provided many participants with the reassurance they needed to better manage their medications. However, some participants reported they were reticent to speak to their community pharmacist due to privacy concerns associated with discussing personal medical information in public or being a burden when the pharmacist was perceived to be ‘busy’. (P11)

But what I really hate when I go to the chemist [pharmacy] is…they want to talk to you—and there are so many people around… I actually feel uncomfortable talking about that in front of other people…it’s probably not actually sinking in because I’m like ‘who’s standing behind me, is there someone here that I know’ you know? And I think that’s probably why I didn’t know a lot about my medications. (P7)

For some participants, accessing a community pharmacist and pharmacy services centred around medication cost whereby participants would seek multiple pharmacies to obtain the best price for their medications. Participants acknowledged this had potential to impact continuity of care facilitated by seeing the same pharmacist.

So, we try to keep costs down where we can…at least by going to that [discount pharmacy] kind of thing…but in a way of a relationship, I wouldn’t know any of the people in there. (P9)