Primary Medication Non-Adherence after Discharge from a General Internal Medicine Service
Open Access
- 2 May 2013
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 8 (5), e61735
- https://doi.org/10.1371/journal.pone.0061735
Abstract
Background Medication non-adherence frequently leads to suboptimal patient outcomes. Primary non-adherence, which occurs when a patient does not fill an initial prescription, is particularly important at the time of hospital discharge because new medications are often being prescribed to treat an illness rather than for prevention. Methods We studied older adults consecutively discharged from a general internal medicine service at a large urban teaching hospital to determine the prevalence of primary non-adherence and identify characteristics associated with primary non-adherence. We reviewed electronic prescriptions, electronic discharge summaries and pharmacy dispensing data from April to August 2010 for drugs listed on the public formulary. Primary non-adherence was defined as failure to fill one or more new prescriptions after hospital discharge. In addition to descriptive analyses, we developed a logistical regression model to identify patient characteristics associated with primary non-adherence. Results There were 493 patients eligible for inclusion in our study, 232 of whom were prescribed new medications. In total, 66 (28%) exhibited primary non-adherence at 7 days after discharge and 55 (24%) at 30 days after discharge. Examples of medications to which patients were non-adherent included antibiotics, drugs for the management of coronary artery disease (e.g. beta-blockers, statins), heart failure (e.g. beta-blockers, angiotensin converting enzyme inhibitors, furosemide), stroke (e.g. statins, clopidogrel), diabetes (e.g. insulin), and chronic obstructive pulmonary disease (e.g. long-acting bronchodilators, prednisone). Discharge to a nursing home was associated with an increased risk of primary non-adherence (OR 2.25, 95% CI 1.01–4.95). Conclusions Primary non-adherence after medications are newly prescribed during a hospitalization is common, and was more likely to occur in patients discharged to a nursing home.Keywords
This publication has 17 references indexed in Scilit:
- Health literacy and medication understanding among hospitalized adultsJournal of Hospital Medicine, 2011
- Prevalence, Predictors, and Outcomes of Primary Nonadherence After Acute Myocardial InfarctionCirculation, 2008
- Organizational Relationships Between Nursing Homes and Hospitals and Quality of Care During Hospital–Nursing Home Patient TransfersJournal of the American Geriatrics Society, 2007
- Impact of Medication Therapy Discontinuation on Mortality After Myocardial InfarctionArchives of Internal Medicine, 2006
- Effect of Medication Nonadherence on Hospitalization and Mortality Among Patients With Diabetes MellitusArchives of Internal Medicine, 2006
- Adherence to MedicationNew England Journal of Medicine, 2005
- Impact of Medication Adherence on Hospitalization Risk and Healthcare CostMedical Care, 2005
- Coding accuracy of administrative drug claims in the Ontario Drug Benefit database.2003
- Adherence With Statin Therapy in Elderly Patients With and Without Acute Coronary SyndromesJAMA, 2002
- Primary non-compliance with prescribed medication in primary care.BMJ, 1993