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

Abstract

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.

Primary drug non-adherence in dermatology patients: prevalence, pattern and reasons

“…This may be because there were more females than males in the study in keeping with females being reported to attend clinics more than males. 1,5,10,14 The frequency of PNA increased with the number of drugs prescribed although there was no difference in frequency of PNA once more than three medications were prescribed. As already documented, cost was one of the reasons for PNA.…”

“…

Drug and medical recommendation non-adherence is a pervasive problem in the medical field. [1][2][3] Non-adherence to recommended medications negatively influences patient outcome with either a slow or no resolution of diseases. Drug non-adherence can be either primary or secondary.

…”

“…2,4,5 Prevalence of primary non-adherence (PNA) varies from 6% to 50%. 1,2,[4][5][6] Primary non-adherence is recorded in patients who have chronic medical and dermatological diseases, in emergency settings and in in-patients. 1,3,[7][8][9][10] Amongst dermatology patients, the prevalence of PNA is 11.7 to 45%.…”

“…1,2,[4][5][6] Primary non-adherence is recorded in patients who have chronic medical and dermatological diseases, in emergency settings and in in-patients. 1,3,[7][8][9][10] Amongst dermatology patients, the prevalence of PNA is 11.7 to 45%. 5,11,12 Prevalence of PNA increases with the number of drugs prescribed; being 33% in patients prescribed one drug to 38% in patients prescribed 5 drugs.…”

Restoration of the health system must not neglect medicines – but who has the power of reform?

“…Younger age and Māori ethnicity were strong predictors of not receiving medicines. 27 I do not advocate a universalist approach to abolishing co-payments as there is evidence that this builds inequity where resourcing is unnecessarily distributed and not targeted. 28 The situation needs addressing, however, and perhaps targeted subsidies facilitated through Māori health providers or prescribers, as deemed necessary, could be usefully introduced.…”