Abstract
BackgroundMedication 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.MethodsWe 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.ResultsThere 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).ConclusionsPrimary 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.
Highlights
Medication adherence is the degree to which a patient takes a medication as prescribed
The reasons for medication non-adherence are varied and include treatment, patient, and health system factors.[6,7,8]. Most research in this area has focused on secondary nonadherence, which occurs when a patient discontinues a medication after filling the initial prescription
Recent studies in the outpatient primary care setting using large administrative databases found primary non-adherence rates ranging from 7% to 24%.[9,10,11]
Summary
Medication adherence is the degree to which a patient takes a medication as prescribed. Non-adherence to prescription medications is associated with a higher risk of death, more frequent hospitalizations, and greater health care expenditure.[1,2,3,4,5] The reasons for medication non-adherence are varied and include treatment, patient, and health system factors.[6,7,8]. Most research in this area has focused on secondary nonadherence, which occurs when a patient discontinues a medication after filling the initial prescription. Primary non-adherence, which occurs when a patient does not fill an initial prescription, is important at the time of hospital discharge because new medications are often being prescribed to treat an illness rather than for prevention
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