Journal of the American Pharmacists Association
ResearchU.S. emergency departments visits resulting from poor medication adherence: 2005–07
Section snippets
Objectives
The goal of this study was to describe emergency department visits related to nonadherence from 2005 to 2007 using the National Hospital Ambulatory Medical Care Survey (NHAMCS) database. Specifically, the objectives of this study were to (1) describe characteristics and trends for emergency department visits related to medication nonadherence and (2) identify associations between patient characteristics and emergency department visits related to medication nonadherence.
Methods
This study was a retrospective cross-sectional database study using the NHAMCS. The NHAMCS, which is conducted annually by the National Center for Health Statistics (NCHS), is a nationally representative sample of visits to outpatient and emergency departments in general, noninstitutional, short-stay, non-Federal hospitals in all 50 states.21 Data were collected by trained hospital staff during a randomly assigned 4-week data period for each sampled hospital, approximately every 15 months. This
Results
An estimated 456,209 ± 68,940 (mean ± SD) nonadherence-related emergency departments visits in the United States occurred from 2005 to 2007, accounting for 0.13% of total visits (Table 1). The yearly percentage of nonadherence-related visits remained steady throughout the study period. Demographic characteristics of emergency department visits both related and unrelated to nonadherence are shown in Table 2. Compared with women, men had more nonadherence-related visits (51.2% vs. 48.8%).
Discussion
Emergency departments visits related to medication nonadherence represented nearly 0.13% of all visits to the emergency department and remained relatively constant from 2005 to 2007. Despite the comparatively small incidence of nonadherence-related emergency department visits, these emergency department visits are burdensome and costly. More than 20% of nonadherence-related visits resulted in a hospital admission, whereas only 12.4% of visits unrelated to nonadherence resulted in a hospital
Limitations
This study had several limitations. The primary limitation was the inability to objectively measure nonadherence. Nonadherence data collected relied on patient perceptions of their medication regimens. Patient reporting bias may have affected our findings by underestimating the number of visits related to medication nonadherence. Similarly, health professionals’ initiative to question patients about their medication adherence and/or conclude that a deteriorated state is a result of poor
Conclusion
Medication nonadherence is an important problem. Patients with Medicaid and those with mental illness, type 2 diabetes, nondependent abuse of drugs, or essential hypertension had an increased probability of having a nonadherence-related emergency department visit. Targeting patients at high risk for nonadherence and providing adherence counseling may improve medication adherence and prevent future emergency department visits.
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Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.
Acknowledgments: To Amisha Patel, PharmD, who contributed to an earlier version of the manuscript.
Previous presentation: American Pharmacists Association Annual Meeting & Exposition, April 3–6, 2009, San Antonio, TX.