Primary compliance with medication prescribed for paediatric patients discharged from a regional hospital

Wright, Helen; Forbes, David; Graham, H. Boyd

doi:10.1046/j.1440-1754.2003.00241.x

Cited by 9 publications

(6 citation statements)

References 7 publications

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“…A previous study of 65 patients also found a lack of significant association, but it may have been too small to detect a difference. 4 In larger studies, younger age has been associated with a higher likelihood of prescription filling 9,10,15 ; however, Beardon et al 10 defined the "younger age" pediatric group as patients ,15 years old. 10 Ekedahl and Månsson' s study 15 included children, but the number of children was unclear.…”

Section: Discussionmentioning

confidence: 99%

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Unfilled Prescriptions in Pediatric Primary Care

2012

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WHAT'S KNOWN ON THIS SUBJECT: Filling a prescription is the first step in medication adherence. Unfilled prescriptions are a documented component of nonadherence in adult and pediatric emergency departments and family practices. No one has reported the proportion of unfilled prescriptions in pediatric primary care. WHAT THIS STUDY ADDS:This study identifies the proportion of unfilled prescriptions in a large sample of primary care pediatric patients. It describes clinical and demographic factors associated with prescription filling and suggests that electronic prescribing may improve adherence. abstract BACKGROUND AND OBJECTIVES: Filling a prescription is the important first step in medication adherence, but has not been studied in pediatric primary care. The objective of this study was to use claims data to determine the rate of unfilled prescriptions in pediatric primary care and examine factors associated with prescription filling. METHODS:This retrospective observational study of pediatric primary care patients compares prescription data from an electronic medical record with insurance claims data. Illinois Medicaid provided claims data for 4833 patients who received 16 953 prescriptions during visits at 2 primary care sites over 26 months. Prescriptions were compared with claims to determine filling within 1 day and 60 days. Clinical and demographic variables significant in univariate analysis were included in logistic regression models. RESULTS:Patients were 51% male; most (84%) spoke English and were African American (38.7%) or Hispanic (39.1%). Seventy-eight percent of all prescriptions were filled. Among filled prescriptions, 69% were filled within 1 day. African American, Hispanic, and male patients were significantly more likely to have filled prescriptions. Younger age was associated with filling within 1 day but not with filling within 60 days. Prescriptions for antibiotics, from one of the clinic sites, from sick/follow-up visits, and electronic prescriptions were significantly more likely to be filled. CONCLUSIONS:More than 20% of prescriptions in a pediatric primary care setting were never filled. The significant associations with clinical site, visit type, and electronic prescribing suggest system-level factors that affect prescription filling. Development of interventions to increase adherence should account for the factors that affect primary adherence. Pediatrics 2012;130:620-626 AUTHORS:

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Section: Discussionmentioning

confidence: 99%

“…2,3 When children are discharged from the hospital with a prescription, up to 25% of prescriptions are not filled. 4 Prescription filling rates are similar or worse after emergency department (ED) visits. Claims data for adult ED prescriptions demonstrate that 16% to 25% of prescriptions are not filled.…”

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confidence: 99%

Unfilled Prescriptions in Pediatric Primary Care

2012

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“…In the model, we also adjusted for differences in the non-adherence rate between different drug therapies [23-25]. "Short-term" drugs were categorised as the ATC-groups in which the average DDD/patient during the year 2006 was below 200 DDD.…”

Section: Methodsmentioning

confidence: 99%

“…However, variation in non-adherence can, to some extent, be explained by the type of drug or in terms of whether the patient's drug therapy is chronic or acute [22-25]. …”

Section: Introductionmentioning

confidence: 99%

Non-adherence to drug therapy and drug acquisition costs in a national population - a patient-based register study

Hovstadius

Petersson

2011

BMC Health Serv Res

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BackgroundPatients' non-adherence to drug therapy is a major problem for society as it is associated with reduced health outcomes. Generally, approximately only 50% of patients with chronic disease in developed countries adhere to prescribed therapy, and the most common non-adherence refers to chronic under-use, i.e. patients use less medication than prescribed or prematurely stop the therapy. Patients' non-adherence leads to high additional costs for society in terms of poor health. Non-adherence is also related to the unnecessary sale of drugs. The aim of the present study was to estimate the drug acquisition cost related to non-adherence to drug therapy in a national population.MethodsWe constructed a model of the drug acquisition cost related to non-adherence to drug therapy based on patient register data of dispensed out-patient prescriptions in the entire Swedish population during a 12-month period. In the model, the total drug acquisition cost was successively adjusted for the assumed different rates of primary non-adherence (prescriptions not being filled by the patient), and secondary non-adherence (medication not being taken as prescribed) according to the patient's age, therapies, and the number of dispensed drugs per patient.ResultsWith an assumption of a general primary non-adherence rate of 3%, and a general secondary non-adherence rate of 50%, for all types of drugs, the acquisition cost related to non-adherence totalled SEK 11.2 billion (€ 1.2 billion), or 48.5% of total drug acquisition costs in Sweden 2006.With the assumption of varying primary non-adherence rates for different age groups and different secondary non-adherence rates for varying types of drug therapies, the acquisition cost related to non-adherence totalled SEK 9.3 billion (€ 1.0 billion), or 40.2% of the total drug acquisition costs.When the assumption of varying primary and secondary non-adherence rates for a different number of dispensed drugs per patient was added to the model, the acquisition cost related to non-adherence totalled SEK 9.9 billion (€ 1.1 billion), or 42.6% of the total drug acquisition costs.ConclusionsOur estimate indicates that drug acquisition costs related to non-adherence represent a substantial proportion of the economic resources in the health care sector. A low rate of primary non-adherence, combined with a high rate of secondary non-adherence, contributes to a large degree of unnecessary medical spending. Thus, efforts of different types of interventions are needed to improve secondary adherence.

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“…A study by Wright et al found that only 75% of prescriptions for paediatric patients written in a regional Western Australian hospital were filled. 6 Patients over the age of 65 years are at an increased risk of medication misadventure particularly on discharge from hospital. 1,2 The aims of this study were to develop a survey tool to assess continuity of medication supply and provision of medicines information on discharge and to evaluate these parameters in patients discharged with either discharge medication or prescriptions for dispensing by a community pharmacy METHOD Pharmacy departments at one metropolitan teaching hospital and two rural hospitals (1 base, 1 district) participated in this study.…”

Section: Continuity Of Medication Supply and Provision Of Patient Infmentioning

confidence: 99%

Continuity of Medication Supply and Provision of Patient Information on Discharge: Development of a Survey Tool

Couch¹,

Quah

et al. 2007

Pharmacy Practice and Res

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Background As described in the national guidelines to achieve continuum of quality use of medicines between hospital and community, hospitals must ensure that continuity of care is not interrupted by the inability of patients to obtain medication on discharge. Aims To develop a survey tool to assess continuity of medication supply and provision of medicines information on discharge. To evaluate these parameters in patients discharged with either discharge medication or prescriptions for dispensing by a community pharmacy. Method Non‐surgical patients aged over 65 years or their carers from one metropolitan teaching hospital and 2 rural hospitals were interviewed by phone 5 to 7 days post‐discharge. 2 interview phases (n = 229) using different interviewers and the same survey tool were conducted in 2005 and 2006. Results 8/227 patients (3%) ran out and missed doses of medication (7 patients 1 day, 1 patient 4 days), with no differences detected between patients receiving discharge prescriptions or discharge medication. Providing medication or prescriptions appeared to influence the timing of doctor visits (average 3 days for metropolitan, 7 to 11 days for rural). 53% of metropolitan doctor visits were for prescriptions only. 90% of rural patients obtained medication on the day of discharge or the day after. 53% of respondents recalled receiving a medication list. 4% did not know the names of their medication nor when to take them; 17% knew some details but not all. Conclusion The survey tool appears to provide consistent data over multiple sites and multiple interviewers. The risk of running out of medication in rural areas would be higher if discharge medications replaced prescriptions due to difficulties accessing doctors. Strategies identified to improve discharge processes include clinical pharmacy checks of discharge prescriptions and more flexibility in supply quantities.

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Primary compliance with medication prescribed for paediatric patients discharged from a regional hospital

Abstract: : Primary compliance was suboptimal, with the majority of unfilled prescriptions being for antibiotics. These findings suggest that a remediable cause of treatment failure may be primary non-compliance with medication in regional settings.

Cited by 9 publications

References 7 publications

Unfilled Prescriptions in Pediatric Primary Care

Unfilled Prescriptions in Pediatric Primary Care

Non-adherence to drug therapy and drug acquisition costs in a national population - a patient-based register study

Continuity of Medication Supply and Provision of Patient Information on Discharge: Development of a Survey Tool

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