Transcript Steven Mooth, Marc Pollack, Amy Daugherty, Emergency

Medication Noncompliance among Elderly Emergency Department Patients
Steven Kleinman, Department of Biology, York College; Steven Mooth, Marc Pollack, Amy
Daugherty, Emergency Department, York Hospital, York PA
Introduction
Medication compliance can be defined as
the extent to which a person’s medication
taking behavior coincides with medical
advice. There are many factors affecting
compliance which include forgetting,
misunderstanding of the directions, feeling
better or worse, and cost related reasons.
Methods
Patient with bed in Emergency Department
70
60
50
40
Inclusion Criteria: 65+ years old, English speaking, not critically ill,
no altered mental status or consciousness
Compliant
% of Patients
30
Noncompliant
20
10
The elderly make up a large portion of the
population who regularly take prescribed
medications. The factor most affecting
medication compliance among this group is
cost.
Prescription drug costs are on the rise and
are doing so faster than the Consumer Price
Index which creates a problem for those on
a fixed income.
Yes
No
Verbal and written consent from
patient for participation in survey
N=500
No
Recorded as
non-participant
N=136
0
<$99
Figure 2. Monthly out of pocket medication expenses for both MPD and
non-MPD patients who are compliant and noncompliant. Percentages are
based on cross tabulations of members in each category.
Survey administered to patient
N=364
70
60
50
% of Patients
Chart review of Emergency
Department encounter
The objectives of this study were to
determine if elderly emergency department
patients are noncompliant for financial
reasons and the impact of Medicare Part D
on compliance and cost.
Hypotheses
The number of noncompliant patients
enrolled in the Medicare Part D program
would be much less than those who are not
enrolled
Those who are noncompliant would have
generally greater out of pocket expenses
than those who were compliant
40
MPD
30
No MPD
20
10
Results
Objectives
>$200
No further action taken
Yes
Medicare Part D is a government program
that was recently established to help pay for
the costs of prescription medications for
those currently covered by Medicare most
of whom are elderly.
$100 - $199
Sample Survey Questions:
1. In the past month, what were your
out-of-pocket medication expenses?
□ No charge
□ $150 to $199
□ $1 to $49
□ $200 to $299
□ $50 to $99
□ $300+
□ $100 to $149
2. During the past year have you for any
reason skipped taking your medication?
□ Yes, often
□ Yes, occasionally
□ No
3. Do you have drug coverage insurance or
another program that helps pay for your
prescription medications?
□ Private Insurance
□ Medicare Part D
□ Prescription Assistance Program
□ PACE/PACENET
□ Other ____________________
□ None
0
<$99
$100 - $199
>$200
Patient Characteristics
Average Age
Average Number of Medications
% Male
% Enrolled in Medicare
Part D
% Noncompliant
76.6
6.3
51.1
50.1
10.2
Figure 3. Monthly out of pocket medication expenses for both compliant and
noncompliant patients who are enrolled in Medicare Part D and those who are
not. MPD represents those who are enrolled in Medicare Part D and no MPD
represents those who are not. Percentages are based on cross tabulations of
members in each category.
Conclusions
56
54
52
50
MPD
% of Patients 48
No MPD
46
44
42
40
Compliant
Noncompliant
Figure 1. Percentage of compliant and noncompliant patients who
are enrolled in Medicare Part D. MPD represents those who
are enrolled in Medicare Part D and no MPD represents those who are
not. Percentages are based on cross tabulations of members in each category.
There is no significant statistical difference
between the numbers of noncompliant patients
enrolled in Medicare Part D and those who are not.
Those patients who are noncompliant generally
have a greater monthly out-of-pocket cost for
medications than those who are compliant.
Acknowledgements
I would like to thank Dr. Bradley Rehnberg for his assistance and guidance throughout
the course of this project. I would also like to thank the students of Emergency Grand
Rounds I for assisting in the data collection process.