Frequency and Predictors of Prescription-related Issues After Hospital Discharge

Sunil Kripalani, MD, MSc; Megan Price, MS; Victoria Vigil, MPH, CHES, CPHQ; Kenneth R. Epstein, MD, MBA

Disclosures

Journal of Hospital Medicine. 2008;3(1):12-19. 

In This Article

Results

In 2005, there were 104,506 eligible adult hospital discharges, corresponding to 96,179 patients. Excluding discharged patients who could not be contacted by the call center or who refused to complete the survey (n = 67,084), multiple surveys of the same patient (n = 3156), and surveys with insufficient data to determine whether there were prescription-related issues (n = 3067) left 31,199 patients available for analysis (effective response rate 32.4%).

More than half the participants (57.0%) were women, and the mean age was 61.1 years (SD 17.8 years). The median number of discharge medications was 4 (range 1-28). The most frequently prescribed drugs were antibiotics and analgesics, followed by several cardiovascular drug classes ( Table 1 ). About 60% of the primary diagnoses were of circulatory, digestive, and respiratory disorders ( Table 1 ). Compared with nonparticipants, the study sample was more likely to be female, older, and covered by Medicare. Study patients also had greater comorbidity, as indicated by greater severity of illness rating and number of discharge medications.

Overall, 7.2% of patients (n = 2253) had prescription-related issues 48-72 hours after hospital discharge. This included not picking up prescribed discharge medications (n = 1797, or 79.8% of issues), not knowing if they were picked up (n = 55 or 2.4%), and admitting to not taking (n = 154, or 6.8%) or not understanding how to take (n = 247, or 11%) medications.

In unadjusted analyses, prescription-related issues were significantly associated with age, sex, insurance type, severity of illness rating, length of stay, number of discharge medications, certain medication types, and major diagnostic category ( Table 2 ). Except for the youngest patients (age < 35 years), having prescription-related issues appeared to be inversely related to patient age. Adults 35-49 years old had the highest frequency of problems filling or taking medications (9.3%), whereas patients 80 years or older had the lowest frequency (5.6%). Analysis by insurance status showed that patients with Medicaid (12.6%) or self-pay/uninsured status (11.9%) had significantly higher rates of prescription issues and patients with non-Medicare HMO or commercial insurance had significantly lower rates (6.1% and 4.9%, respectively). Being prescribed at least 6 medications or taking ACE inhibitors, inhalers, oral hypoglycemics, or insulins was also associated with a higher frequency of prescription-related problems in unadjusted analyses. Patients prescribed antibiotics or anticoagulants were less likely to report problems in unadjusted analyses.

In multivariable models, age, sex, insurance type, severity of illness, number of medications, and certain medication types were independently associated with prescription-related issues after discharge ( Table 3 ). Seniors reported significantly fewer problems than the youngest patients (65-79 years, OR 0.69; ≥ 80 years, OR 0.59). Those with Medicare HMOs, Medicaid, or no insurance had more difficulty obtaining and taking prescription medications (OR 1.29, 1.33, and 1.31, respectively),whereas patients with HMO or commercial insurance plans had less difficulty (OR 0.68 and 0.51, respectively). Prescription-related problems were also more common among women (OR 1.11), patients with higher severity of illness (moderate SOI, OR 1.12; major/extreme SOI, OR 1.23), and those with 6 or more discharge medications (OR 1.35). In adjusted analyses, inhalers were the only type of medication associated with a significantly higher frequency of problems (OR 1.14).

Analyses were repeated using only failure to pick up medications as the dependent variable, and results were similar (not shown).

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