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.

The objective was to investigate the familial occurrence of the neurodegenerative condition amyotrophic lateral sclerosis (ALS), Parkinson's disease and dementia in the relatives of Irish ALS patients. A retrospective case control chart review study was conducted to extract the neurological family histories of Irish ALS patients and controls who attended the National Neurological Centre between January 2001 and January 2006. In total, details were extracted from 197 ALS and 235 general neurology pedigrees. Using the recurrence risk, lambda, ALS (lambda (1st degree)=7.77), Parkinson's disease (lambda (1st degree)=2.67) and dementia (lambda (1st degree)=6.21) were reported more frequently in relatives of ALS patients compared to those of non-ALS controls. Within sporadic ALS kindreds, the presence of neurodegenerative disease was not uniformly distributed. This study supports the conjecture that neurodegenerative disease aggregates within ALS kindreds, and indicates a shared genetic susceptibility towards some neurodegenerative phenotypes.

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