Patient compliance is a major determinant in the success of most medical therapies. Data from the pediatric literature have shown patient noncompliance with taking medication to be as high as 50 percent. The majority of studies have focused on this aspect of the problem; few studies, however, have reported whether prescriptions are actually filled. Previous studies have revealed that prescription nonfilling rates range from 5 to 20 percent in the primary care setting. Fewer data are available on the rate of filling prescriptions written in an emergency department. Matsui and colleagues performed a prospective study to determine the rate of compliance with filling prescriptions written in a pediatric emergency department. They also attempted to determine the reasons why prescriptions were not filled in hopes of devising strategies to improve compliance.
Patients enrolled included children of all ages who were discharged from a pediatric emergency department with at least one written drug prescription during a three-month period. The emergency department records were reviewed by one of the authors, and telephone follow-up using a standard questionnaire was conducted. The interview questions were designed so as not to reveal the reason for the study. Information requested included whether the prescription was filled, the reason(s) for not filling the prescription (if this was the case), the degree of satisfaction with the emergency department visit, if another prescription had been received and whether there was subsequent follow-up by another physician. The first telephone call was placed between 48 and 72 hours after discharge, and at least five additional telephone calls were made to each household in an attempt to reach the caregiver. Compliance was defined as having the prescription filled on the same day as the emergency department visit or on the following day.
Of the 1,222 children who were eligible for the study, a telephone follow-up was successfully conducted for 1,014 (83 percent). The mean age of the children was 4.5 ± 4.2 years, and the mean time to follow-up was about five days after emergency department discharge. The four most common prescriptions included antibiotics (72.2 percent), other anti-infective drugs (17.8 percent), beta2 agonists (14.5 percent) and steroids (14.0 percent). The most common diagnosis was otitis media. Overall, compliance was 92.7 percent. The most common reasons for not filling prescriptions included believing the medication was unnecessary (27 percent), financial (6.8 percent) and not enough time (6.8 percent).
In the compliant and the noncompliant groups, 79 percent of the parents reported that they had a discounted pharmaceutical plan that covered the medications. Prescriptions were not filled for 74 children (7.3 percent). Of this group, 17 prescriptions were filled two or more days after the emergency department visit, and 57 prescriptions were not filled at all. Specific reasons cited for non-compliance included dissatisfaction (see accompanying table) with the explanation of the medical problem, treatment instructions or instructions for further follow-up. All three of these reasons were determined to be statistically significant. In addition, a trend toward a higher admission rate among the small number of children who did not have prescriptions filled was evident.
The authors conclude that at least 7 percent of prescriptions written for pediatric patients in the emergency department are not filled. Significant reasons for this noncompliance seem to be poor communication between the physician and the patient's caregiver. Prescription compliance may improve with education of the caregiver (and child) by the physician as to the medical problem and the need for and benefits from the medication. Only a small percentage of prescriptions were not filled because of financial reasons. Interestingly, the seriousness of the child's medical condition may not ensure compliance. The authors cite results from a study showing that prescriptions for long-term medications were filled at a higher rate than prescriptions for acute illnesses. The authors also note that the 7 percent figure is lower than rates in studies that included adults seen in an emergency department, which found that 22 percent of adults had failed to fill one or more prescriptions when seen at a follow-up visit.
editor's note: I was surprised at this relatively low figure because I have seen data from ambulatory settings stating that up to 50 percent of prescriptions are not filled. The primary reason appears to be poor communication, not financial, as one might expect. This study should give any physician reason to pause the next time a patient is handed a prescription, especially if it is to treat an acute problem.—j.t.k.