Prescription noncompliance: contribution to emergency department visits and cost

doi:10.1016/S0736-4679(99)00109-2

The Journal of Emergency Medicine

Volume 17, Issue 5, September–October 1999, Pages 909-912

Presented at the Sixth International Conference on Emergency Medicine, Sydney Australia, November 1996.

https://doi.org/10.1016/S0736-4679(99)00109-2 Get rights and content

Abstract

We randomly surveyed 100 patients in the acute care section of a large urban university hospital Emergency Department (ED) on 6 days with regard to the existence of and reasons for prescription noncompliance. Noncompliance was considered a major factor contributing to the ED visit if: (1) no medications had been taken for at least 48 h before the ED visit; (2) the medications, when previously taken, had routinely controlled the condition for which the patient was presenting to the ED; and (3) no other significant cause or illness was believed to have precipitated the ED visit. ED, admissions, and yearly medication costs were calculated for all patients. Noncompliance was found to be a contributing factor in the cases of 22 patients (22%). The most common medications involved were phenytoin and albuterol. Cost was the most common reason for noncompliance (11 [50%]). The average ED charge per noncompliant patient discharged was $576.61. Six noncompliant patients were admitted at an average cost of $4,834.62. The average cost of a year’s medication was $520.72. Noncompliance with drug prescriptions is a significant contributor to ED visits and health care costs.

Introduction

Prescription drug noncompliance, whether due to financial or other reasons, is a significant health care problem. It has been shown to contribute to a rise in both morbidity and health care expense for patients with asthma, seizures, and other medical problems 1, 2, 3, 4, 5, 6, 7.

We performed a random survey of 100 emergency department (ED) patients to study the contribution of prescription drug noncompliance to ED visits and costs.

Section snippets

Materials and methods

A random survey of 100 ED patients was performed. All patients presenting in the acute care side of the ED on 6 days were surveyed about the existence of and reasons for drug noncompliance. Patients were surveyed on two day, two evening, and two night shifts. The setting was a large urban university hospital ED. The survey was done each shift on all patients who were present at a single time. There were no exclusion criteria.

Two investigators performed the survey. One was an ED attending

Results

One hundred patients were surveyed. All patients were awake, alert, and able and willing to answer the survey questions. Twenty-two patients (22%) fit the criteria for noncompliance as a major contributing factor to their ED visit. Thirteen (59%) were female, and 9 (41%) were male. The age range was 19 to 68 years, with an average of 42. The most common presenting conditions were asthma attacks in seven patients and seizures in six patients. Table 1 lists the uncontrolled diseases. The most

Discussion

Previous studies have demonstrated the existence of prescription drug noncompliance. One study reported a 5% noncompliance rate in filling prescriptions in a general medical population (8). Rashid found that approximately 20% of patients in a clinic population failed to fill prescriptions (9). Saunders looked at next day follow-up of prescriptions written in an ED and found a 22% noncompliance both overall and in the self-pay population (10). A previous survey of ED patients about to be

Limitations

There are three limitations to our study: (1) There is no exactly matched control group that was known to be compliant; (2) The data are based on patient self-reporting. (In regard to these two limitations, we still feel that the criteria used to determine noncompliance were very specific and that the noncompliance contributed to these ED visits. We also feel the patients surveyed answered the questions they were asked honestly and accurately.); and (3) The costs described in the study are

Conclusion

Prescription drug noncompliance is a significant contributing factor to ED visits and health care costs.

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There are more references available in the full text version of this article.

Cited by (47)

Pharmacy Calls for Prescription Clarification at an Academic Emergency Department
2022, Journal of Emergency Medicine
Citation Excerpt :
Studies have found that 11–32% of these prescriptions are never filled (1,2). Unfortunately, prescription nonadherence (filling the medication, proper administration, and timing of doses) increases health care costs through disease progression, medical complication, and an increase in ED visits and hospital admissions (1,3). Identification of the barriers to successful treatment is prudent, given the impact of medication nonadherence.
Approximately two-thirds of patients discharged from an emergency department (ED) are prescribed at least one medication. Prescription clarification by outpatient pharmacies for ED patients can lead to delays for patients and added workload.
This study aims to describe prescriptions requiring clarification prior to being dispensed by an outpatient pharmacy for patients recently discharged from an ED.
This study was conducted at an urban, 61-bed academic ED. Prescription clarification forms were used to identify common causes for outpatient pharmacies to contact the ED to clarify prescriptions prior to dispensation. Clarification types were reviewed and classified. Descriptive statistics were used to present the classification types.
There were 1278 documented calls to the ED for prescription clarification that were classified as clarification of directions for use (611, 47.7%), insurance or affordability issues (182, 14.2%), dose (172, 13.4%), medication availability (126, 9.8%), lost or missing prescription (93, 7.3%), patient allergy or adverse event (62, 4.8%), duplication in therapy (17, 1.3%), and clarification of medication ordered (17, 1.3%). When grouped into provider, system, or patient-related issues, provider issues were noted to be most frequent clarifications (862 clarifications, 67.3%), followed by system issues (325 clarifications, 25.4%), and finally, patient-related issues (93 clarifications, 7.3%).
Clarification of directions for use, insurance or affordability issues, and clarification of the dose were the most common reasons that outpatient pharmacies contacted an ED regarding a prescription for a recently discharged patient.
Cost-related medication nonadherence among elderly emergency department patients
2019, American Journal of Emergency Medicine
Economic Impact of Emergency Visits due to Drug-Related Morbidity on a Brazilian Hospital
2017, Value in Health Regional Issues
Citation Excerpt :
In this study, lack of adherence to treatment accounted for 36% of the total cost. Olshaker et al. [35] reported a corresponding figure of 22%, with an average treatment cost of US $576 for patients who visited only the emergency department and US $4834 for those who were admitted to the hospital. Our data suggest an average emergency department charge of US $891 per nonadherent patient.
To estimate the cost of managing drug-related morbidity (DRM) that leads to visits to the emergency department of a Brazilian hospital.
This is a cost-of-illness study based on a retrospective cross-sectional analysis of patients’ medical records. A questionnaire and analysis of medical records were used to identify patients who were being admitted to the emergency department because of DRM. The direct medical costs of patient management were estimated using a microcosting analysis, and a sensitivity analysis was conducted using the emergency department visit rates due to DRM reported in the literature.
Of the total patients interviewed, 14.6% sought emergency care because of DRM and 58.9% were considered preventable. Mean treatment costs were US $900 ± $1,569 (range US $18–$10,847). An extrapolation based on all emergency visits in the last year resulted in annual total treatment costs of US $7.5 million (US $1.1–$1.4 million). It was observed that 39.3% of the total cost of DRM was attributed to adverse drug reactions, 36.9% to nonadherence to treatment, and 16.9% to incorrect dosages.
Adverse drug reactions and nonadherence to treatment are important causes of morbidity and cost to the health service. Much of this resource is spent to treat preventable cases of DRM, which represents a great waste of resources.
Racial differences in beliefs of physician prescribing practices for low-cost pharmacy options
2014, Journal of Emergency Medicine
Citation Excerpt :
The National Council on Patient Information and Education estimated prescription medication noncompliance costs United States (US) health care industry $177 billion annually (10−12). An earlier survey conducted among ED patients determined prescription drug noncompliance was a major reason for an ED visit for 22% of the respondents, and half of those surveyed stated cost of the medication was the reason for noncompliance (4). The cost of prescription medications can be a substantial barrier to patients and a lever for excessive health care expenditures (2,13).
Previous studies have reported that certain populations are sensitive to high out-of-pocket drug costs, and drug noncompliance leads to poorer health outcomes.
Our aim was to measure patient awareness of discount pharmacy options, cost barriers to medication access, and beliefs about health care provider’s use of low-cost medications.
This cross-sectional 17-item survey was administered to patients in the emergency department of an urban trauma center in February 2011. Differences in responses by sex and race groups were assessed. A logistic regression model was created to estimate the association of sociodemographic factors and medication use with awareness of discount pharmacy options.
Five hundred and fifty-two surveys were analyzed. Among respondents who were prescribed medications within the past year, three fourths of patients felt comfortable asking physicians for cheaper medicines. Slightly more than half were aware of low-cost pharmacy options, and 78% of these respondents correctly listed at least one of these pharmacies. Caucasian patients were more comfortable than African American patients asking for cheaper medicines (82.5% vs. 72.2%; p < 0.05) and were more aware of low-cost prescription programs (63.9% vs. 43.5%; p < 0.001). When adjusted for insurance status and current medication use, Caucasian patients were 2.7 times more likely to name a valid discount pharmacy option compared to African Americans (95% confidence interval 1.85−4.07).
This study suggests populations may be more uncomfortable initiating a discussion about medication costs and selection of lower-cost alternatives. Health care providers may need to develop communication strategies in which medication cost is addressed with sensitivity and consistency.
Compliance with emergency department discharge instructions
2014, Journal of Emergency Nursing
The purpose of this study was to assess patient understanding of ED discharge instructions. It is essential for ED patients to understand their discharge instructions. ED staff face unique challenges when providing information in a distraction-filled, limited-time setting, often with no knowledge of the patient's medical history.
A qualitative study was conducted with a sample of patients discharged from our emergency department. Data were collected via a semi-structured interview.
A total of 36 patients participated in the study; 29 patients were discharged with a drug prescription, and complementary investigations were scheduled for 3 patients. Most patients were satisfied with the time staff spent explaining the discharge instructions. However, some patients admitted that they did not intend to fully comply with the medical prescription. Nearly half of the patients reported difficulties understanding their drug prescription (the dose or purpose of the treatment). Most patients said that their poor understanding primarily was related to lack of clarity of the written prescription.
Even the most comprehensive instructions may not be clearly understood. Despite the patients' high stated levels of satisfaction with communication in the emergency department, more than half of patients failed to comply with important discharge information. Health care staff must be aware of the importance of discharge information. Further research is needed to improve the patient discharge process.
U.S. emergency departments visits resulting from poor medication adherence: 2005-07
2013, Journal of the American Pharmacists Association
To describe characteristics and trends for emergency department visits related to medication nonadherence and to identify associations between patient characteristics and emergency department visits related to medication nonadherence.
Retrospective cross-sectional study.
National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2005 to 2007.
Patients who had an emergency department visit for medication nonadherence.
NHAMCS data were weighted to yield national estimates of emergency department visits related to medication nonadherence. Descriptive frequencies were calculated for visits related and unrelated to medication adherence. A binary logistic regression model was used to identify covariates for nonadherence.
National estimates of emergency department visits related to medication nonadherence.
An estimated 456,209 ± 68,940 (mean ± SD) nonadherence-related visits occurred. Of visits related to nonadherence, 29% resulted from mental health disorders. Significant covariates of nonadherence-related visits included age, payment source, and primary diagnosis. Visits for patients with mental illness (odds ratio 22.74 [95% CI 14.68–34.20]), type 2 diabetes (15.80 [5.20–48.06]), nondependent abuse of drugs (11.85 [3.83–36.65]), or essential hypertension (11.06 [3.99–30.61]) were significantly associated with the probability that an emergency department visit was related to nonadherence. More than 20% of emergency department visits related to medication nonadherence resulted in hospital admission, whereas only 12.7% of visits unrelated to nonadherence resulted in hospital admission (P < 0.0001).
Medication nonadherence is an important problem. Targeting patients at high risk for nonadherence, especially patients with mental illness, may improve medication adherence and prevent future emergency department visits.

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¹: Administration of Emergency Medicine is coordinated by Eugene Kercher, MD, of Kern Medical Center, Bakersfield, California and Richard F. Salluzzo, MD, of Conemaugh Meridian Health Group, Johnstown, Pennsylvania

View full text

Administration of Emergency MedicinePrescription noncompliance: contribution to emergency department visits and cost1

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Limitations

Conclusion

J Allergy Clin Immunol

Am J Emerg Med

An economic evaluation of asthma in the United States

N Engl J Med

Asthma mortality comparison between New Zealand and England

Br Med J

Seizure disorders and trauma

South Med J

Seizures and seizure care in an emergency department

Epilepsia

Administration of Emergency Medicine
Prescription noncompliance: contribution to emergency department visits and cost1