Patient Care

Social Isolation, Polypharmacy Predict Medication Noncompliance Post-Discharge in Cardiac Patients


Clinical question: What are predictors of primary medication nonadherence after discharge?

Background: Primary nonadherence occurs when a patient receives a prescription at hospital discharge but does not fill it. Predictors of post-discharge primary nonadherence could serve as useful targets to guide adherence interventions.

Study design: RCT, secondary analysis.

Setting: Two tertiary care, U.S. academic hospitals.

Synopsis: Using the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study database, investigators conducted a secondary analysis of adults hospitalized for acute coronary syndrome or acute decompensated heart failure who received pharmacist-assisted medication reconciliation, discharge counseling, low-literacy adherence aids, and a follow-up phone call. The prevalence of primary nonadherence one to four days post-discharge was 9.4% among 341 patients. In subsequent multivariate analysis, significant factors for noncompliance were living alone (odds ratio 2.2, 95% CI 1.01-4.8, P=0.047) and more than 10 total discharge medications (odds ratio 2.3, 95% CI 1.05-4.98, P=0.036).

Limitations to this study include biases from patient-reported outcomes, lack of patient copayment data, and limited characterization of discharge medication type.

Bottom line: Among patients hospitalized for cardiac events, social isolation and polypharmacy predict primary medication nonadherence to discharge medications despite intensive pharmacist counseling.

Citation: Wooldridge K, Schnipper JL, Goggins K, Dittus RS, Kripalani S. Refractory primary medication nonadherence: prevalence and predictors after pharmacist counseling at hospital discharge [published online ahead of print August 21, 2015]. J Hosp Med. doi: 10.1002/jhm.2446.

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