Patient nonadherence to filling discharge medication prescriptions from the emergency department: Barriers and clinical implications

Abstract

The majority of patients who received a prescription during an ED visit filled their discharge medications. Sex, ethnicity, and payer class were independently associated with nonadherence.

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

“…30 While the female sex is reported to be a predictor of low adherence, findings are often inconsistently reported in the literature. 29 31 32 In our study, men and women presented in similar numbers, and women were shown to be more non-adherent than men; however, this was not significant.…”

“…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.…”

“…Nevertheless, access to a pharmacy remains a significant barrier to filling a prescription for many patients, 35 36 and the costs of travel may compete with other demands, leading to non-adherence with possible worsening of the condition and/or readmission. Where an onsite pharmacy has been available at an ED, adherence rates were shown to be substantially higher, 29 justifiably arguing the need for the provision of late-night pharmacies in areas where accessibility and cost are barriers for patients.…”

“…Overall primary non-adherence in our study is higher than that of previously reported US studies, which cite non-adherence rates of 7%-35%. 29 As there is a paucity of research available on primary medication non-adherence in NZ EDs, we were unable to compare this result with other hospitals across NZ where it is likely that there are fewer patients with complex health needs and/or differing health beliefs.…”

“…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.…”