Primary Medication Non-Adherence after Discharge from a General Internal Medicine Service

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.

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“…Another factor that could affect our results is that all the prescriptions were issued by primary healthcare physicians, while it has been reported that patients seeing specialists have their prescription dispensed to a greater extent than those seeing GPs . It is also important to consider that we assessed primary non‐adherence in general practice, while many studies have reported primary non‐adherence following discharge from hospital, where the proportion of primary non‐adherence tends to be higher . Lastly, many studies define primary non‐adherence as the proportion of all issued prescriptions that are never dispensed, instead of only prescriptions issued to new users, as in our study.…”

“…Secondary non-adherence has been extensively researched in the last decades, often using pharmacy dispensing databases (7,8). Although primary non-adherence has been less extensively studied, the prevalence of primary non-adherence has been reported to be between 2.4% and 30.7% (5,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”

Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis

“…6,7 This frequent use of health care services is mainly due to lack of understanding of a treatment plan, nonadherence to medical therapy, unawareness of CHF symptom exacerbation, and irregular follow-up. [8][9][10][11][12] Lack of coordination and communication between hospitalists and primary care physicians (PCPs) has been documented. 13,14 PCPs too often do not receive discharge summaries, 15 and when they do receive them, the summaries often lack appropriate documentation of medication indication and advice for follow-up.…”

Medication adherence 1 month after hospital discharge in medical inpatients

“…Also, most studies focus on rates of secondary non‐adherence and medications for chronic conditions. There are far fewer data on the rate of primary non‐adherence to new medication changes made during a hospital admission . The aim of this study was to determine the rate of adherence to medications after discharge from acute general medical hospital admission and identify factors that may be associated with non‐adherence.…”