Dr. Gibson
Clinical question: Is there an association between chronic medication adherence and emergency department (ED) visits and hospitalizations?
Background: Medication adherence for hypertension and diabetes has been shown to be associated with decreased health care visits and decreased health care costs, however it is usually examined for one medication or medication group. Adherence can vary between different medications and patients may take more than one medication. This study examines the association between overall medication adherence for 23 chronic medications and ED visits and hospitalizations.
Study design: Retrospective chart review
Setting: Patients with diabetes or hypertension, aged 50-74 years, treated with at least one antihypertensive or antidiabetic medication in Clalit Health Services health maintenance organization in Tel Aviv, Israel.
Synopsis: A total of 268,792 patients were included in the study. 81.1% had hypertension, 59.5% had diabetes, and 40.6% had both. Information on medications prescribed was collected for 2017. The mean number of antihypertensive and antidiabetic medications prescribed was 2.2 ±1.1. Monthly filled prescription was used as a proxy for medication use. Each patient’s adherence rate was calculated for each medication, then averaged to obtain the personal adherence rate. Personal adherence rates were stratified into five categories of increasing adherence with 4.2% of participants in the lowest category (adherence 1-20%) and 42.5% in the highest category (adherence of 81-100%). Information about ED visits and hospitalizations were collected from the electronic medical record for 2016-2018. ED visits were recorded in 19.1%, 8.1% were hospitalized in internal medicine wards, and 3.8% were hospitalized in surgical wards. The odds of an ED visit or hospitalization were consistently lower in the group with highest adherence compared to lowest adherence. In 2017 the adjusted odds ratio for ED visits was 0.64, confidence interval [0.61, 0.67], hospitalization in internal medicine wards 0.56 [0.52, 0.60] and hospitalization in surgical wards 0.63 [0.53, 0.70]. Similar findings were seen when examining the years 2016 and 2018.
Bottom line: The probability of ED visit or hospitalization is lower in patients with high medication adherence. Hospitalists should consider examining patients’ medication adherence, and tools to increase adherence, to prevent readmission.
Citation: Shani M, et al. Associations of chronic medication adherence with emergency room visits and hospitalizations. J Gen Intern Med. 2022;37(5):1060-4.
Dr. Gibson is an assistant professor of medicine at the Cleveland Clinic Lerner College of Medicine and staff physician in the department of hospital medicine and department of medical operations at the Cleveland Clinic, Cleveland.