Medication adherence in elderly patients receiving home health services following hospital discharge.
OBJECTIVE
To assess prevalence and risk factors for medication under- and overadherence in a two-week period following hospital discharge in adults > or = 65 years.


METHODS
Prospective, cohort study.


METHODS
Three home healthcare agencies in Madison, Wisconsin, and surrounding vicinity.


METHODS
One hundred forty-seven older participants taking three or more medications who were hospitalized for medical illness, received home nursing after discharge, and completed the two-week interview.


METHODS
The main outcome measures were having at least one medication with less than 70% adherence (underadherence) and having at least one medication with more than 120% adherence (overadherence) based on pill counts.


RESULTS
Forty-five (30.6%) participants were underadherent and 27 (18.4%) participants were overadherent with at least one medication> In a multivariate model, underadherence was predicted by poor cognition (OR 2.5; 95% CI 1.02 to 6.10) and higher medication use (OR 1.16; 95% CI 1.03 to 1.31, for each 1-unit increase in number of medications). Both poor cognition and low education were significantly associated with overadherence in univariate analysis; however, neither variable was significant once included in the multivariate model.


CONCLUSIONS
Under- and overadherence to medications is common after hospital discharge. Poor cognition and a greater number of medications were associated with underadherence. Poor and lower education were markers for overadherence; however, further study is needed to determined whether these are independent predictors. Patients who have impaired cognition or are taking a greater number of medications after hospitalization may benefit from targeted interventions to monitor and improve medication compliance.
Gray
S L
SL
School of Pharmacy, University of Washington, Seattle 98195-7630, USA. slgray@u.washington.edu
Mahoney
J E
JE
Blough
D K
DK
D000203:Activities of Daily Living; D000368:Aged; D003071:Cognition; D004522:Educational Status; D005260:Female; D005853:Geriatrics; D006304:Health Status; D006699:Home Care Services; D006801:Humans; D008297:Male; D010349:Patient Compliance; D010351:Patient Discharge; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D015995:Prevalence; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012307:Risk Factors; D014922:Wisconsin
D004364:Pharmaceutical Preparations