Research
U.S. emergency departments visits resulting from poor medication adherence: 2005–07

https://doi.org/10.1331/JAPhA.2013.12213Get rights and content

Objectives

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.

Design

Retrospective cross-sectional study.

Setting

National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2005 to 2007.

Patients

Patients who had an emergency department visit for medication nonadherence.

Intervention

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.

Main outcome measures

National estimates of emergency department visits related to medication nonadherence.

Results

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).

Conclusion

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.

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.

References (41)

  • E. Vermeire et al.

    Patient adherence to treatment: three decades of research: a comprehensive review

    J Clin Pharm Ther

    (2001)
  • E.T. MacDonald et al.

    Improving drug compliance after hospital discharge

    Br Med J

    (1977)
  • P. Kissinger et al.

    Compliance with public sector HIV medical care

    J Natl Med Assoc

    (1995)
  • M.R. DiMatteo

    Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research

    Med Care

    (2004)
  • S. Malhotra et al.

    Drug-related visits to the medical emergency department: a prospective study from India

    Int J Clin Pharmacol Ther

    (2001)
  • S. Malhotra et al.

    Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance

    Postgrad Med J

    (2001)
  • M. Mazer et al.

    Risk for cost-related medication nonadherence among emergency department patients

    Acad Emerg Med

    (2011)
  • B.S. Prince et al.

    Drug-related emergency department visits and hospital admissions

    Am J Hosp Pharm

    (1992)
  • M.J. Tafreshi et al.

    Medication-related visits to the emergency department: a prospective study

    Ann Pharmacother

    (1999)
  • P.J. Zed et al.

    Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study

    CMAJ

    (2008)
  • Cited by (35)

    • Managing the onset of a new disease in older age: Housing wealth, mortgage borrowing, and medication adherence

      2022, Social Science and Medicine
      Citation Excerpt :

      The consequences of skipping medications can be severe, leading to increases in emergency room visits, hospitalizations, and preventable deaths (Campbell et al., 2020; Heisler et al., 2010; Sokol et al., 2005). Aside from implications for patients, medication non-adherence increases government health care costs (Heaton et al., 2013; Piña et al., 2021). One study found that non-adherence is associated with $100 billion in avoidable medical spending in the U.S. each year (Kleinsinger, 2018).

    • Prevalence and Categorization of Drug-Related Problems in the Emergency Department

      2022, Journal of Emergency Medicine
      Citation Excerpt :

      It is most likely a more complex process with multiple contributing factors. Some factors potentially contributing to DRPs may not be easily identified from the electronic health record, such as ED visits related to medication nonadherence (19). In addition to decreasing ED utilization, early recognition of a DRP may improve patient care downstream by identifying patients who may require further intervention in their medication regimen or discharge counseling before hospital dismissal.

    • Barriers to medication adherence in the emergency department: A cross-sectional study

      2021, American Journal of Emergency Medicine
      Citation Excerpt :

      Our data also showed that 10.4% of our population returned to the ED because of problems related to medication nonadherence. These ED visits are more likely to result in hospital and ICU admission than those unrelated to nonadherence [13,14]. Our data, in addition to many more studies describing increased healthcare utilization and adverse effects of both acute and chronic illnesses caused my medication nonadherence, illuminate the significant burden medication nonadherence places on the healthcare system [7,13-19].

    • Hunger pains? SNAP timing and emergency room visits

      2020, Journal of Health Economics
      Citation Excerpt :

      First, we look at conditions that have been studied in the context of SNAP timing, specifically, hypoglycemia (Heflin et al., 2017), hypertension (Ojinnaka and Heflin, 2018), asthma (Heflin et al., 2019) and conditions related to pregnancy (Arteaga et al., 2018).11 We also explore other conditions that are shown to lead to ER admission for non-adherence to medications, such as heart failure (Roebuck et al., 2011) and mental disorders (Heaton et al., 2013 – ICD9 295* 296* 297* 298* and 299*).12 We further consider anxiety and depression (300.0* and 311) as they are highly correlated with food insecurity (Leung et al., 2015; Whitaker et al., 2006).

    • The impact of pharmacists on medication safety in mental health: A narrative review

      2024, JACCP Journal of the American College of Clinical Pharmacy
    View all citing articles on Scopus

    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.

    View full text