Predictors of medication adherence postdischarge: The impact of patient age, insurance status, and prior adherence

Journal of Hospital Medicine - Tập 7 Số 6 - Trang 470-475 - 2012
Marya J. Cohen1, Shimon Shaykevich2, Courtney Cawthon3, Sunil Kripalani4, Michael K. Paasche‐Orlow5, Jeffrey L. Schnipper6
1Division of General Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
2Division of General Medicine, Brigham & Women's Hospital, Boston, Massachusetts
3Institute for Medicine and Public Health, Vanderbilt Center for Health Services Research, Nashville, Tennessee
4Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee
5Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
6BWH Hospitalist Service and Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

Tóm tắt

AbstractBACKGROUND:Optimizing postdischarge medication adherence is a target for avoiding adverse events. Nevertheless, few studies have focused on predictors of postdischarge medication adherence.METHODS:The Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL‐CVD) study used counseling and follow‐up to improve postdischarge medication safety. In this secondary data analysis, we analyzed predictors of self‐reported medication adherence after discharge. Based on an interview at 30‐days postdischarge, an adherence score was calculated as the mean adherence in the previous week of all regularly scheduled medications. Multivariable linear regression was used to determine the independent predictors of postdischarge adherence.RESULTS:The mean age of the 646 included patients was 61.2 years, and they were prescribed an average of 8 daily medications. The mean postdischarge adherence score was 95% (standard deviation [SD] = 10.2%). For every 10‐year increase in age, there was a 1% absolute increase in postdischarge adherence (95% confidence interval [CI] 0.4% to 2.0%). Compared to patients with private insurance, patients with Medicaid were 4.5% less adherent (95% CI −7.6% to −1.4%). For every 1‐point increase in baseline medication adherence score, as measured by the 4‐item Morisky score, there was a 1.6% absolute increase in postdischarge medication adherence (95% CI 0.8% to 2.4%). Surprisingly, health literacy was not an independent predictor of postdischarge adherence.CONCLUSIONS:In patients hospitalized for cardiovascular disease, predictors of lower medication adherence postdischarge included younger age, Medicaid insurance, and baseline nonadherence. These factors can help predict patients who may benefit from further interventions. Journal of Hospital Medicine 2012;. © 2012 Society of Hospital Medicine

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Journal of Hospital Medicine

Tập 7 Số 6

470-475

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