In a test of services geared toward making sure patients took their prescribed medications after leaving the emergency room, none made a difference, a large new study suggests.
Based on the experiment involving nearly 4,000 ER patients, researchers found that information packets, personal assistance and even access to an on-call medical librarian to answer questions about the drugs did not lead patients to fill more prescriptions or to take them as directed when they left the hospital.
There is a great deal of evidence that patients who don’t follow medication regimens have worse health outcomes and end up spending more for healthcare in the long run, according to the study’s lead author Dr. Melissa McCarthy, who researches health policy and emergency medicine at George Washington University in Washington, D.C.
The National Library of Medicine created Medline Plus, an online drug information database, to encourage people to take medications as directed, but its effectiveness hadn’t been measured, McCarthy said.
“We wanted these ‘information prescriptions’ tested and evaluated, if people were given more information about their drugs are they more likely to take them?” she told Reuters Health.
McCarthy and her colleagues selected 3,940 people leaving three emergency rooms with prescriptions for antibiotics or for medications to treat respiratory, cardiac, gastrointestinal or nervous system distress (the drugs most commonly prescribed in emergency rooms) and divided the patients into four groups.
One group went through normal hospital procedures, another received practical assistance with filling the prescription if requested, the third got MedlinePlus prescription information online and in printed form and the fourth got both practical assistance and prescription information.
For practical assistance, participants were directed to a convenient pharmacy, informed of prescription discount services if cost was a concern, and given help getting to the pharmacy if needed.
The information group got detailed documentation on why the medicine was prescribed, its benefits and side effects.
The combination group had access to both forms of assistance as well as the phone number of a medical librarian to answer additional questions.
One week after ER discharge, 88 percent of patients had filled their prescription, according to pharmacy records, and in a phone interview 48 percent reported taking the medication as prescribed. Those percentages did not differ between the participating groups, according to results in the Annals of Emergency Medicine.
“The whole idea was to make this more patient centered, make it easier, make the process better, and I don’t think it worked,” McCarthy said.
According to Dr. Benjamin Sun of Oregon Health and Science University in Portland, who was not involved in the study, one reason the ‘information prescription’ didn’t work might be because ER doctors don’t have long-term relationships with their patients, which would help them reinforce the need to take medication.
It’s also possible that some patients had good reason for not following directions, McCarthy said. Based on talking to study subjects, she learned that many either felt better soon and stopped taking the medicine or visited their primary care doctors soon after the emergency room and received different instructions or medications.
“For many acute conditions, it may not be a big deal that the patient stopped their prescribed medications, for example, (the patient) received antibiotics for skin infection, symptoms cleared after a day, so the patient stopped taking antibiotics,” Sun told Reuters Health in an email.
“It kind of made sense why the patient didn’t follow directions,” McCarthy said.
The medicines prescribed in the study were largely common generics, which might mean that many people had heard of them and didn’t feel the need to use extra information, McCarthy said.
Some people in the study may not have been able to afford the prescriptions even when pointed to social assistance programs, she said. But 80 percent of the patients had prescription coverage through insurance, so cost wouldn’t have been a barrier.
Although large studies are usually best, future research might focus on a more precise group of patients, Sun told Reuters Health.
“One possible way to improve the intervention is to focus on the treatment of high risk conditions where it really is important to take the medication,” like prescriptions for warfarin for blood clots, he said.
SOURCE: Annals of Emergency Medicine, online April 5 2013
Does Providing Prescription Information or Services Improve Medication Adherence Among Patients Discharged From the Emergency Department? A Randomized Controlled Trial
Of the 3,940 subjects enrolled and randomly allocated to treatment, 86% (N=3,386) completed the follow-up interview. Overall, primary adherence was 88% and persistence was 48%. Across the sites, primary adherence and persistence did not differ significantly between usual care and the prescription information or services groups. However, at site C, subjects who received the practical prescription information or services (odds ratio [OR]=2.4; 95% confidence interval [CI] 1.4 to 4.3) or combination prescription information or services (OR=1.8; 95% CI 1.1 to 3.1) were more likely to fill their prescription compared with usual care. Among subjects prescribed a drug that treats an underlying condition, subjects who received the practical prescription information or services were more likely to fill their prescription (OR=1.8; 95% CI 1.0 to 3.1) compared with subjects who received usual care.
Prescription filling and receiving medications as prescribed was not meaningfully improved by offering patients patient-centered prescription information and services.
Melissa L. McCarthy, ScD,
Ru Ding, MS,
Nancy K. Roderer, MLS,
Donald M. Steinwachs, PhD,
Melinda J. Ortmann, PharmD,
Julius Cong Pham, MD, PhD,
Edward S. Bessman, MD,
Gabor D. Kelen, MD,
Walter Atha, MD,
Rodica Retezar, MD, MPH,
Sara C. Bessman, MS,
Scott L. Zeger, PhD
Received 18 October 2012; received in revised form 7 January 2013 and 28 January 2013; accepted 4 February 2013. published online 05 April 2013.