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Adherence to emergency department discharge prescriptions

Published online by Cambridge University Press:  21 May 2015

Corinne M. Hohl ,
Riyad B. Abu-Laban ,
Jeffrey R. Brubacher ,
Peter J. Zed ,
Boris Sobolev ,
Gina Tsai ,
Patricia Kretz ,
Kevin Nemethy ,
Jan Jaap Bijlsma  and
Roy A. Purssell
Corinne M. Hohl*
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC Faculty of Medicine, University of British Columbia, Vancouver, BC Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC
Riyad B. Abu-Laban
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC Faculty of Medicine, University of British Columbia, Vancouver, BC Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC
Jeffrey R. Brubacher
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC Faculty of Medicine, University of British Columbia, Vancouver, BC Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC
Peter J. Zed
Affiliation:
Department of Pharmacy, Queen Elizabeth II Health Sciences Centre, Capital Health, Halifax, NS Department of Emergency Medicine and College of Pharmacy, Dalhousie University, Halifax, NS
Boris Sobolev
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC
Gina Tsai
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC
Patricia Kretz
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC
Kevin Nemethy
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC
Jan Jaap Bijlsma
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC Faculty of Medicine, University of British Columbia, Vancouver, BC
Roy A. Purssell
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC Faculty of Medicine, University of British Columbia, Vancouver, BC
*
Department of Emergency Medicine, Vancouver General Hospital, 855 W 12th Ave., Vancouver BC V5Z 1M9; [email protected]

Abstract

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Objective:

Nonadherence to prescribed medication is associated with increased morbidity and mortality as well as the increased use of health services. The main objective of our study was to assess the incidence of prescription-filling and medication adherence in patients discharged from the emergency department (ED).

Methods:

This was a prospective, observational study carried out at a Canadian tertiary care ED with an annual census of 69 000. We enrolled a convenience sample of patients being discharged with a prescription. We queried a provincial prescription-dispensing database 2 weeks later to determine whether prescriptions had been filled. We used a standardized follow-up interview to assess adherence and whether or not the patient experienced an adverse drug-related event (ADRE) or an unplanned revisit to an ED or clinic.

Results:

Of the 301 patients who agreed to participate, follow-up was successful for 258 (85.7%). Fifty-one patients (19.8%, 95% confidence interval [CI] 15.4%–25.1%) failed to fill their discharge prescriptions and 104 (40.3%, 95% CI 34.5%–46.4%) did not adhere to 1 or more medications. Antibiotics were associated with a lower odds ratio (OR) of nonadherence (OR 0.21, 95% CI 0.08–0.52). There was a trend toward increasing nonadherence in patients who reported an ADRE (OR 1.84, 95% CI 0.98–3.48) or had 2 or more medications coprescribed (OR 1.71, 95% CI 0.95–3.09). There was also a trend toward a higher risk of a revisit to an ED or clinic in nonadherent patients (OR 1.75, 95% CI 0.94–3.25).

Conclusion:

Approximately 4 in 10 patients discharged from the ED did not adhere to his or her prescribed medication. Our results suggest that patients who are prescribed antibiotics are more likely to be adherent, and that further evaluation of the associations between nonadherence, ADREs, the coprescription of 2 or more medications and the use of health services is warranted.

Keywords

adherencecomplianceadverse drug-related eventsreturn visitshealth services useemergency medicine
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 2 , March 2009 , pp. 131 - 138
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

References

1.Spraycar, M. Stedman’s medical dictionary. 26th ed. Baltimore (MD): Williams and Wilkins; 1995.Google Scholar
2.Chui, MA, Deer, M, Bennett, SJ, et al. Association between adherence to diuretic therapy and health care utilization in patients with heart failure. Pharmacotherapy 2003;23:326–32.Google Scholar
3.Dew, MA, Kormos, RL, Roth, LH, et al. Early post-transplant medical compliance and mental health predict physical morbidity and mortality one to three years after heart transplantation. J Heart Lung Transplant 1999;18:549–62.CrossRefGoogle ScholarPubMed
4.DiMatteo, MR, Giordani, PJ, Lepper, HS, et al. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care 2002;40:794–811.CrossRefGoogle ScholarPubMed
5.Gehi, AK, Ali, S,Na, B, et al. Self-reported medication adherence and cardiovascular events in patients with stable coronary heart disease. The Heart and Soul Study. Arch Intern Med 2007;167:1798–803.Google Scholar
6.Olshaker, JS, Barish, R, Naradzay, J, et al. Prescription noncompliance: contribution to emergency department visits and cost. J Emerg Med 1999;17:909–12.CrossRefGoogle ScholarPubMed
7.Hope, CJ, Wu, J,Tu, W, et al. Association of medication adherence, knowledge, and skills with emergency department visits by adults 50 years or older with congestive heart failure. Am J Health Syst Pharm 2004;61:2043–9.Google Scholar
8.Simpson, SH, Eurich, DT, Majumdar, SR, et al. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ 2006;333:15.CrossRefGoogle ScholarPubMed
9.Kajioka, EH, Itoman, EM, Li, ML, et al. Pediatric prescription pick-up rates after ED visits. Am J Emerg Med 2005;23:454–8.CrossRefGoogle ScholarPubMed
10.Matsui, D, Joubert, GI, Dykxhoorn, S, et al. Compliance with prescription filling in the pediatric emergency department. Arch Pediatr Adolesc Med 2000;154:195–8.Google Scholar
11.Saunders, CE. Patient compliance in filling prescriptions after discharge from the emergency department. AmJ Emerg Med 1987;5:283–6.Google Scholar
12.Thomas, EJ, Burstin, H, O’Neil, A, et al. Patient noncompliance with medical advice after the emergency department visit. Ann Emerg Med 1996;27:49–55.CrossRefGoogle ScholarPubMed
13.Dinh, MM, Chu, M, Zhang, K. Self-reported antibiotic compliance: emergency department to general practitioner follow up. Emerg Med Australas 2005;17:450–6.CrossRefGoogle ScholarPubMed
14.Lam, F, Stevenson, FA, Britten, N, et al. Adherence to antibiotics prescribed in an accident and emergency department: the influence of consultation factors. Eur J Emerg Med 2001;8:181–8.CrossRefGoogle Scholar
15.Manos, D, Petrie, D, Beveridge, R, et al. Inter-observer agreement using the Canadian Emergency Deparment Triage and Acuity Scale. CJEM 2002;4:16–22.CrossRefGoogle Scholar
16.Hohl, CM, Dankoff, J, Colacone, A, et al. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med 2001;38:666–71.CrossRefGoogle ScholarPubMed
17.International drug monitoring: the role of the hospital. World Health Organ Tech Rep Ser 1966;425:5–24.Google Scholar
18.Canadian Pharmacists Association. Compendium of pharmaceuticals and specialties. The Canadian drug reference for health professionals. Ottawa (ON): The Association.Google Scholar
19.Chao, J, Nau, DP, Aikens, JE. Patient-reported perceptions of side effects of antihyperglycemic medication and adherence to medication regimens in persons with diabetes mellitus. Clin Ther 2007;29:177–80.CrossRefGoogle ScholarPubMed
20.McDonald, HP, Garg, AX, Haynes, RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA 2002;288:2868–79.Google Scholar
21.van Dijk, L, Heerdink, ER, Somai, D, et al. Patient risk profiles and practice variation in nonadherence to antidepressants, anti-hypertensives and oral hypoglycemics. BMC Health Serv Res 2007;7:51.Google Scholar