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Adherence to emergency department discharge prescriptions

Published online by Cambridge University Press:  21 May 2015

Corinne M. Hohl ,
Riyad B. Abu-Laban ,
Jeffrey R. Brubacher ,
Peter J. Zed ,
Boris Sobolev ,
Gina Tsai ,
Patricia Kretz ,
Kevin Nemethy ,
Jan Jaap Bijlsma  and
Roy A. Purssell
Corinne M. Hohl*
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC Faculty of Medicine, University of British Columbia, Vancouver, BC Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC
Riyad B. Abu-Laban
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC Faculty of Medicine, University of British Columbia, Vancouver, BC Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC
Jeffrey R. Brubacher
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC Faculty of Medicine, University of British Columbia, Vancouver, BC Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC
Peter J. Zed
Affiliation:
Department of Pharmacy, Queen Elizabeth II Health Sciences Centre, Capital Health, Halifax, NS Department of Emergency Medicine and College of Pharmacy, Dalhousie University, Halifax, NS
Boris Sobolev
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC
Gina Tsai
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC
Patricia Kretz
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC
Kevin Nemethy
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC
Jan Jaap Bijlsma
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC Faculty of Medicine, University of British Columbia, Vancouver, BC
Roy A. Purssell
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC Faculty of Medicine, University of British Columbia, Vancouver, BC
*
Department of Emergency Medicine, Vancouver General Hospital, 855 W 12th Ave., Vancouver BC V5Z 1M9; chohl@interchange.ubc.ca

Abstract

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Objective:

Nonadherence to prescribed medication is associated with increased morbidity and mortality as well as the increased use of health services. The main objective of our study was to assess the incidence of prescription-filling and medication adherence in patients discharged from the emergency department (ED).

Methods:

This was a prospective, observational study carried out at a Canadian tertiary care ED with an annual census of 69 000. We enrolled a convenience sample of patients being discharged with a prescription. We queried a provincial prescription-dispensing database 2 weeks later to determine whether prescriptions had been filled. We used a standardized follow-up interview to assess adherence and whether or not the patient experienced an adverse drug-related event (ADRE) or an unplanned revisit to an ED or clinic.

Results:

Of the 301 patients who agreed to participate, follow-up was successful for 258 (85.7%). Fifty-one patients (19.8%, 95% confidence interval [CI] 15.4%–25.1%) failed to fill their discharge prescriptions and 104 (40.3%, 95% CI 34.5%–46.4%) did not adhere to 1 or more medications. Antibiotics were associated with a lower odds ratio (OR) of nonadherence (OR 0.21, 95% CI 0.08–0.52). There was a trend toward increasing nonadherence in patients who reported an ADRE (OR 1.84, 95% CI 0.98–3.48) or had 2 or more medications coprescribed (OR 1.71, 95% CI 0.95–3.09). There was also a trend toward a higher risk of a revisit to an ED or clinic in nonadherent patients (OR 1.75, 95% CI 0.94–3.25).

Conclusion:

Approximately 4 in 10 patients discharged from the ED did not adhere to his or her prescribed medication. Our results suggest that patients who are prescribed antibiotics are more likely to be adherent, and that further evaluation of the associations between nonadherence, ADREs, the coprescription of 2 or more medications and the use of health services is warranted.

Keywords

adherencecomplianceadverse drug-related eventsreturn visitshealth services useemergency medicine
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 2 , March 2009 , pp. 131 - 138
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

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