Who is least likely to fill a prescription after a pediatric emergency department visit?

To find out what factors raise the risk of a prescription going unfilled after an emergency department (ED) visit, researchers conducted a study in children discharged with a prescription from the pediatric ED (PED) of an urban safety-net hospital serving a low-income population.

The study sample included 111 children aged 2 weeks to 17 years (mean, 6.56 years). Parents completed a survey on basic sociodemographic and household information; health history; and attitudes about the medication, the physician who prescribed it, and the treatment plan. Parents were evaluated for health literacy. Investigators contacted parents of the children 7 to 10 days after the PED visit to learn whether the prescription had been filled and confirmed positive responses with the pharmacy.

Overall, nearly a third of the families did not fill the prescriptions. Investigators had hypothesized that certain patient attributes and factors in patient-provider and patient-health system interactions would predict nonadherence, but they found no association between any of these predictors and whether prescriptions were filled.

Commentary

"Primary nonadherence" is the term used to describe failure of a patient or parent to fill a prescription after a medical visit. The 32% rate of primary nonadherence found in this study was no surprise to researchers, who cite previous studies with nonadherence rates of 23% to 66%. What was surprising was their being unable to identify any factors that could be used to predict which patients are most at risk. One possible solution, although not a simple one, is to dispense medications at the hospital before a patient is discharged from the ED. A February 2012 technical report from the American Academy of Pediatrics Committee on Emergency Medicine examines this option and explains both the barriers to and advantages of this approach (Pediatrics. 2012;129[2]:e562). -Michael Burke, MD