title: Refractory primary medication nonadherence: Prevalence and predictors after pharmacist counseling at hospital discharge.
abstract: Successful secondary prevention of cardiovascular disease relies on medication therapy; thus, minimizing nonadherence is a focus for improving patient outcomes. Receipt of discharge medication counseling has been associated with improved drug knowledge and adherence. We evaluated the prevalence and predictors of postdischarge primary nonadherence (not filling new prescriptions) in patients who received discharge medication counseling by a pharmacist (ie, refractory to intervention) as part of a randomized controlled trial. Of 341 patients, 9.4% of patients did not fill all prescriptions after discharge. Patients who were living alone were more likely to not fill their medications compared to those who were married or cohabitating (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.01-4.8, P = 0.047). Patients who were discharged with greater than 10 medications were also more likely to demonstrate primary nonadherence (OR: 2.3, 95% CI: 1.05-4.98, P = 0.036). Patients with lower income were less likely to fill prescriptions in univariate analysis (P = 0.04) but not multivariable analysis. Our study demonstrates that among patients hospitalized for acute cardiovascular events, primary medication nonadherence persisted despite discharge medication counseling. Targeted or multimodal approaches that address patient-specific barriers, such as cost, social isolation, and polypharmacy, in addition to discharge counseling, may further facilitate adherence.
authors: Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee.|Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Kathleene
authors: K
authors: Wooldridge
authors: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.|Hospitalist Service, Brigham and Women's Hospital, Boston, Massachusetts.|Department of Medicine, Harvard Medical School, Boston, Massachusetts.
authors: Jeffrey L
authors: JL
authors: Schnipper
authors: Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, Tennessee.|Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Kathryn
authors: K
authors: Goggins
authors: Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee.|Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.|Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Robert S
authors: RS
authors: Dittus
authors: Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.|Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, Tennessee.|Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Sunil
authors: S
authors: Kripalani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010353:Patient Education as Topic; D010595:Pharmacists; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012934:Social Isolation; D012959:Socioeconomic Factors; D055815:Young Adult; D016903:Drug Monitoring