Does Providing Prescription Information or Services Improve Medication Adherence Among Patients Discharged From the Emergency Department? A Randomized Controlled Trial

McCarthy, Melissa L.; Ding, Ru; Roderer, Nancy K.; Steinwachs, Donald M.; Ortmann, Melinda J.; Pham, Julius; Bessman, Edward S.; Kelen, Gabor D.; Atha, Walter; Retezar, Rodica; Bessman, Sara C.; Zeger, Scott L.

doi:10.1016/j.annemergmed.2013.02.002

Cited by 22 publications

(23 citation statements)

References 24 publications

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“…2 In the medication adherence study contact information was obtained via in-person interview, and patients received $10 gift cards for completing follow-ups. Our own experience conducting research on older adults is similar; short-term follow-up can be achieved for 85% to 90% of older patients if one obtains comprehensive contact information in the ED and makes considerable efforts to reach the patient.…”

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confidence: 99%

Delayed Telephone Consent in Emergency Medicine Research

Platts‐Mills¹,

Keil

2013

Acad Emerg Med

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We appreciate the work of Offerman and colleagues, 1 which describes the process of enrolling emergency department (ED) patients in a study by identifying them using the ED record and contacting them by telephone after the ED visit to request consent. We agree with the authors' conclusion that delayed telephone consent is generally ethical and efficient, but offer the following observations.The investigators report that of 506 eligible patients identified by emergency providers in the ED, 501 (99.0%) patients or their surrogates were successfully reached by phone using phone numbers in the ED medical records, and 500 (99.8%) consented to the study. These very high rates of reaching and consenting patients are not consistent with our experience or that of others performing ED-based research.A recent large study of medication adherence among ED patients obtained 1-week follow-up for 86% of patients (3,386 of 3,940). 2 In the medication adherence study contact information was obtained via in-person interview, and patients received $10 gift cards for completing follow-ups. Our own experience conducting research on older adults is similar; short-term follow-up can be achieved for 85% to 90% of older patients if one obtains comprehensive contact information in the ED and makes considerable efforts to reach the patient. 3 When we used similar methods to that of Offerman et al. (i.e., making calls to patients using information from the ED record), only approximately 50% of patients or surrogates were contacted. 4 The other prior similar study referenced by Offerman et al. reached 80% of patients (167 of 209) using delayed consent, which was similar to the 81% (180 of 221) reached following ED consent. 5 The much higher rates of contact reported by Offerman et al. may in part be because of sociodemographic differences in the study population or because the study question is essentially a continuation of the patient's clinical care. Regardless of the explanation, a 99% contact rate is unusually high, and future researchers should neither expect to obtain nor be criticized for not obtaining a similar response rate. Further, we think it unlikely that deferred consent is likely to provide consistently higher follow-up rates than ED consent.The other conclusion the authors draw from their study is that this approach is ethical. We agree that in most situations making an unsolicited phone call to request study participation following an ED visit is ethical, but the details matter. Calls to home phones for individuals who have recently visited the ED for complaints related to substance abuse or an early pregnancy may be unwelcome and unethical, even if the study does not contain an intervention.

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confidence: 99%

Delayed Telephone Consent in Emergency Medicine Research

Platts‐Mills¹,

Keil

2013

Acad Emerg Med

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“…The majority of these interventions (16 of 26 studies) focused on medication-taking [13;17–20;23–28;30;31;34;36;37], while five addressed effective prescribing [16;22;29;35;38], four utilized shared decision-making [14;15;32;33], and one addressed effective feedback [21]. Educational interventions were frequently delivered by research personnel or multidisciplinary teams.…”

Section: Resultsmentioning

confidence: 99%

Patient-centered interventions to improve medication management and adherence: A qualitative review of research findings

Kuntz¹,

Safford²,

Singh³

et al. 2014

Patient Education and Counseling

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Objective Patient-centered approaches to improving medication adherence hold promise, but evidence of their effectiveness is unclear. This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains: shared decision-making, methods to enhance effective prescribing, systems for eliciting and acting on patient feedback about medication use and treatment goals, and medication-taking behavior. Methods We reviewed literature on interventions that fell into these domains and were published between January 2007 and May 2013. Two reviewers abstracted information and categorized studies by intervention type. Results We identified 60 studies, of which 40% focused on patient education. Other intervention types included augmented pharmacy services, decision aids, shared decision-making, and clinical review of patient adherence. Medication adherence was an outcome in most (70%) of the studies, although 50% also examined patient-centered outcomes. Conclusions We identified a large number of medication management interventions that incorporated patient-centered care and improved patient outcomes. We were unable to determine whether these interventions are more effective than traditional medication adherence interventions. Practice Implications Additional research is needed to identify effective and feasible approaches to incorporate patient-centeredness into the medication management processes of the current health care system, if appropriate.

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“…Younger patients are also thought to have lower adherence due to less established or continuous relationships with a primary care provider, 31 and in an ED setting, Open access healthcare providers are usually unfamiliar with their patient's lifestyle and/or resources. 10 Medication cost is commonly cited as a significant barrier to medication adherence 29 and predominantly affects those living in poverty. The rate of ED use increases with the level of neighbourhood deprivation; in 2014/2015, one in five people who presented at ED resided in the most deprived neighbourhoods.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…Open access of adult prescriptions [7][8][9][10] and 23%-66% of children's prescriptions will not be filled post-discharge. 11 Predicting which factors are responsible for poor medication adherence is an essential step in guiding and developing adherence support interventions.…”

Section: Introductionmentioning

confidence: 99%

Primary medication non-adherence at Counties Manukau Health Emergency Department (CMH-ED), New Zealand: an observational study

2020

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ObjectivesTo measure primary medication non-adherence (failure to fill prescription medicines) in patients discharged from the emergency department (ED), and to determine whether sociodemographic factors, smoking status and access to a general practitioner affect prescription filling. Little is known about primary medication non-adherence in EDs, and less so in New Zealand (NZ). Identifying reasons for non-adherence will enable development of strategies to improve adherence and reduce morbimortality.Design and settingAn observational study based on patient data from the ED of a large public hospital in South Auckland, NZ.ParticipantsData were collected from 1600 patients discharged between 28 April–6 May and 28 July–9 August 2014. Data were included if patients were residents within the Auckland Regional Public Health Service boundaries, admitted to ED and discharged with a prescription. Data were excluded if patients were admitted to another ward, transferred to another hospital or left the ED without seeing a doctor.Results992 patients were included in the study, the majority were under 10 years (32.6%), of Pacific Island descent (42.8%), NZ-born (67.7%) and living in the most socioeconomically deprived areas (78.1%). Almost 50% of patients failed to fill all prescription medications. Simple linear regression analysis indicated that non-adherence was significant for those 10–24 years (n=236; adherence=47.2%; p<0.05), of NZ Māori ethnicity (n=175; 51.3%; p=0.01), unemployed (n=77; 46.8%; p<0.01), homemakers (n=66; 45.7%; p<0.01), students (n=228; 55.6%; p<0.05) and cigarette smokers (n=139; 50.3%; p<0.01). Following multivariable analysis, the strongest predictors for non-adherence were those aged between 10 and 17 years (n=116; p<0.01), the unemployed (n=77; p=0.01) and homemakers (n=66; p=0.01).ConclusionsAge and occupation were the greater predictors of non-adherence; however, no other significant differences were found. Since this study, changes to prescription co-payments have been made. Further research is warranted to assess whether this change has more recently affected the rates of non-adherence.

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Does Providing Prescription Information or Services Improve Medication Adherence Among Patients Discharged From the Emergency Department? A Randomized Controlled Trial

Cited by 22 publications

References 24 publications

Delayed Telephone Consent in Emergency Medicine Research

Delayed Telephone Consent in Emergency Medicine Research

Patient-centered interventions to improve medication management and adherence: A qualitative review of research findings

Primary medication non-adherence at Counties Manukau Health Emergency Department (CMH-ED), New Zealand: an observational study

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