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Not Getting It the First Time

Not Getting It the First Time

Frank Diamond

Forget about patients not refilling their prescriptions. Many don’t fill them the first time, according to a study in the Canadian journal Plos One (http://tinyurl.com/non-adherence-study).

New prescriptions were given to 232 patients from April to August 2010 at St. Michael’s Hospital in Toronto. Twenty-eight percent exhibited primary non-adherence at 7 days after discharge; 24 percent at 30 days. Perhaps more surprising is that patients discharged to home had a better adherence rate (26 percent) than those discharged to a nursing home (43 percent). There were no significant demographic differences between the adherent and non-adherent groups. Participants were all 66 or older; the average age was 78.

“In some instances, nursing homes may not have robust systems in place to ensure that the discharge prescription is rapidly approved by the nursing home physician and then sent to a pharmacy,” the study states.

The analysis looked at adherence to antibiotics and medications for coronary artery disease, heart failure, stroke, diabetes, COPD, and osteoporosis.

“Primary medication non-adherence occurred despite the significant life event of a hospital admission and the interdisciplinary nature of the general internal medicine service at a teaching hospital,” the study states. “Our study demonstrates that primary non-adherence is not limited to the primary care setting and emphasizes that hospital discharge is an important time to be aware of the potential for primary medication non-adherence.”

We at Managed Care have reported on both medication non-adherence (http://tinyurl.com/Diamond-adherence) and the possible pitfalls in transitions of care (http://tinyurl.com/Diamond-transitions), keeping in mind the link between the two — which this study reinforces.

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