title: Medication use among inner-city patients after hospital discharge: patient-reported barriers and solutions.
abstract: OBJECTIVE
  To better characterize medication-related problems among inner-city patients after hospital discharge and to suggest potential interventions.
  
  
  METHODS
  Between August 9, 2005, and April 3, 2006, we interviewed 84 patients hospitalized with acute coronary syndromes at Grady Memorial Hospital in downtown Atlanta, GA, and contacted them by telephone about 2 weeks later. English-speaking patients who managed their own medications were studied. Patients reported their adherence with filling prescriptions and taking medications after discharge, as well as barriers to and potential enablers of proper medication use.
  
  
  RESULTS
  Most of the 84 respondents were African American (74 [88%]), male (49 [58%]), and middle-aged (mean age, 54.5 years). Only 40% of patients filled their prescriptions on the day of discharge, 20% filled them 1 or 2 days later, and 18% waited 3 to 9 days; 22% had not filled their prescriptions by the time of the follow-up telephone call (median, 12 days; interquartile range, 8-18 days). Transportation, cost, and wait times at the pharmacy were cited as the main barriers. Many patients reported it was somewhat or very difficult to understand why they were prescribed medications (21%), how to take them (11%), or how to reconcile them with the medications they had been taking before hospitalization (16%). About half the patients (40 [48%]) reported some degree of nonadherence after discharge. Patients noted that several forms of assistance could improve medication use after discharge, including lower medication costs (75%), a follow-up telephone call (68%), transportation to the pharmacy (65%), pharmacist counseling before discharge (64%), and a pillbox (56%).
  
  
  CONCLUSIONS
  Patients often delay filling prescriptions and have difficulty understanding medication regimens after hospital discharge. Interventions that reduce medication costs, facilitate transportation, improve medication counseling, and supply such organizing aids as pillboxes might be beneficial.
authors.affiliation: Division of General Internal Medicine and Public Health, Vanderbilt Center for Health Services Research, 1215 21st Ave S, Ste 6000 Medical Center East, Nashville, TN 37232, USA. sunil.kripalani@vanderbilt.edu
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
authors.forename: Laura E
authors.initials: LE
authors.lastname: Henderson
authors.forename: Terry A
authors.initials: TA
authors.lastname: Jacobson
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D003376:Counseling; D004358:Drug Therapy / Q000191:economics; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D010351:Patient Discharge; D012944:Social Support; D012959:Socioeconomic Factors; D014186:Transportation; D016312:Treatment Refusal / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*