title: Does providing prescription information or services improve medication adherence among patients discharged from the emergency department? A randomized controlled trial.
abstract: OBJECTIVE
  We determine whether prescription information or services improve the medication adherence of emergency department (ED) patients.
  
  
  METHODS
  Adult patients treated at one of 3 EDs between November 2010 and September 2011 and prescribed an antibiotic, central nervous system, gastrointestinal, cardiac, or respiratory drug at discharge were eligible. Subjects were randomly assigned to usual care or one of 3 prescription information or services intervention groups: (1) practical services to reduce barriers to prescription filling (practical prescription information or services); (2) consumer drug information from MedlinePlus (MedlinePlus prescription information or services); or (3) both services and information (combination prescription information or services). Self-reported medication adherence, measured by primary adherence (prescription filling) and persistence (receiving medicine as prescribed) rates, was determined during a telephone interview 1 week postdischarge.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Prescription filling and receiving medications as prescribed was not meaningfully improved by offering patients patient-centered prescription information and services.
authors.affiliation: Department of Health Policy, George Washington University, Washington, DC, USA. melmccar@gwu.edu
authors.forename: Melissa L
authors.initials: ML
authors.lastname: McCarthy
authors.forename: Ru
authors.initials: R
authors.lastname: Ding
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Roderer
authors.forename: Donald M
authors.initials: DM
authors.lastname: Steinwachs
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Ortmann
authors.forename: Julius Cong
authors.initials: JC
authors.lastname: Pham
authors.forename: Edward S
authors.initials: ES
authors.lastname: Bessman
authors.forename: Gabor D
authors.initials: GD
authors.lastname: Kelen
authors.forename: Walter
authors.initials: W
authors.lastname: Atha
authors.forename: Rodica
authors.initials: R
authors.lastname: Retezar
authors.forename: Sara C
authors.initials: SC
authors.lastname: Bessman
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zeger
mesh_terms: D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods*; D055656:Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D055815:Young Adult; D016903:Drug Monitoring