Social Emergency Medicine
Abstracts
Lisa Ambrose, MFA
Spectrum Health System
Lauren Southerland, MD
The Ohio State University
Background: There has been a rise in prescription drug costs over the past decade. The purpose of this study is to gain a preliminary understanding of cost-related medication nonadherence (CRMN) disclosure among elderly emergency department (ED) patients and to describe the extent to which CRMN is associated with other economic and psychosocial risk factors.
Methods: This is a prospective cross-sectional survey of non emergency elderly patients (> 65 years) presenting to the ED at one university-affiliated hospital and a rural medical center over a 6-month study period. The survey used previously validated questions that have been tested in both paper ⁄ pencil and computer formats. To screen whether patients were at risk for CRMN, participants were asked ‘‘Have money concerns ever been a reason you haven’t taken a medication?” Patients were also asked standardized questions about their current economic situation, risk factors, general health, emotional stress and the availability of social support in their life. Discrete variables were analyzed with the use of chi-square test; unpaired t-tests for continuous and ordinal data.
Results: A total of 281 respondents completed the survey. The mean age was 75.6 years (range 65 to 95 years). Patients took an average of 6.4 (+ 4.5) medications each day. Overall, 12.4% (25/201) of patients presenting to an urban ED admitted to CRMN. In comparison, 25% (20/80) of rural ED patients experienced CRMN (p = 0.009). Risk factors for CRMN were similar in both groups and included polypharmacy, number of recent hospitalizations, and a recent decline in functional ability. Methods commonly described to pay for medicines included: pharmacy discount programs (41.5%), spending less on basic needs (23.4%); borrowing money (21.3%), skipping doses of medicines to save money (14.9%); increased credit card debt (12.8%); and asking a relative to buy medicines (11.7%).
Conclusion: Geriatric patients presenting to a rural ED were twice as likely to experience cost-related medication non-adherence as patients from urban setting. Discharge planning without addressing the underlying risk factors for CRMN can drive avoidable ED utilization and hospital readmissions. Further studies are needed to develop methods to coordinate health-related social services in our community and help patients cope medication expenses.