Survey on psychiatric patients who failed to retrieve their prescribed medication in an outpatient setting

This abstract has open access

Abstract Description

Introduction:

One clear indicator of whether a patient has been adhering to the pharmacological treatment is whether they have retrieved their prescription from the pharmacy upon attending their consultation. It is good practice for doctors to check whether their patients’ have retrieved their prescriptions, and open discussion with them if they have not.

Objectives:

The primary objective of this study is to determine the number of patients who failed to retrieve their medication over a 6-month period. The secondary objectives of this study to is to 1) look for associated factors that may cause patients to repeatedly fail to retrieve their prescription, and 2) examine the action of doctors after a patient’s failure to retrieve their prescription.

Methodology:

Comparisons between data of patients who repeatedly failed to retrieve their prescription and patients who subsequently retrieved their prescription after the documented instance of non-retrieval were analyzed.

Results:

Over the course of 6 months from January 2017 until June 2017, a total of 233 cases were documented to have not retrieved their medication after their consultation. Among these patients, 86 (37%) did not retrieve their prescription again upon subsequent consultation.

Patients who failed to retrieve their medication before were likely to not retrieve their medication again (P=0.000).

Patients whose failure to retrieve their medication was acknowledged by their doctors, discussed in their next consultation, with adjustment to their drug regime, were associated with success in retrieving their medication subsequently (P=0.003, 0.000 and 0.000 respectively).

Conclusion:

Patients who had failed to retrieve their prescriptions in the past are at a higher risk of failure to retrieve their prescriptions again. Conversely, doctors’ awareness, open communication, and adjustment of treatment accordingly are associated with successful retrieval of their subsequent prescriptions.

Clinicians should be more aware of patients who are at a higher risk of non-compliance, and actively engage in discussion with them regarding their concerns over their management and drug regime.

Abstract ID :

HAC54

Submission Type

HA Staff

Authors (including presenting author) :

Au C

Affiliation :

Department of Psychiatry, United Christian Hospital

Introduction :

Pharmacotherapy plays an important role in the management of psychiatric patients. Poor adherence to medication among psychiatric patients results in increase risk of relapse and suboptimal improvement in symptomatology. Therefore, psychiatrists should be mindful of the possibility of patients not adhering to the prescribed medication, and explore the reasons behind such non-adherence. One clear indicator of whether a patient has been adhering to the pharmacological treatment is whether they have retrieved their prescription from the pharmacy upon attending their consultation. Within the hospital authority, the computer system allows doctors to review whether their patients have successfully retrieved their prescription, as failure to do so would result in the prescription record being marked as “unvetted”. It is good practice for doctors to review their patients’ computer system, including whether they have retrieved their medication, and open discussion with them if they have not. Frank communication with patients regarding their treatment plan enhances rapport, assists patients in understanding their condition more, and assists doctors in understanding their patients’ concerns. This in turn facilitates the management to be more tailor made to each patient, and increases the patients’ likelihood to adhere to their treatment.

Objectives :

Methodology :

This is a retrospective study. The computerized records of patients who failed to retrieve their prescription over the period of January, 2017, to June, 2017, were retrieved. Patients’ basic demographics, namely age and gender, are recorded. The complexity of their drug regime is determined by counting the number of medications in the unvetted prescription. Computerized records are checked to determine whether the patient previously had unvetted prescriptions. Whether patients’ subsequent prescription in the following consultation was retrieved was also recorded. Whether patients’ subsequent consultation was advanced was recorded. Clinicians’ notes were also reviewed with regards to their documentation of their actions subsequent to their patients’ failure to retrieve their prescription. Information recorded include clinician’s documented acknowledgement that the failure of retrieval took place, whether clinicians documented on their discussion with their patients with regards to their medication, and whether medication was adjusted. Comparisons between data of patients who repeatedly failed to retrieve their prescription and patients who subsequently retrieved their prescription after the documented instance of non-retrieval were analyzed using SPSS.

Result & Outcome :

Over the course of 6 months from January 2017 until June 2017, a total of 238 cases were documented to have not retrieved their medication after their consultation. Among them, 5 patients were either admitted before their next appointment, or defaulted their subsequent appointment. Since it is not possible to analyze their behavior for the purpose of this study, these patients were excluded from analysis. This made up a total of 233 patients who were analyzed. Among patients who failed to retrieve their medication after their consultation, 102 (43.8%) were male and 131 (56.2%) were female. Their mean age was 43.7 years, and the mean period of their non-retrieved prescription was 91.1 days. Among these patients, 86 (37%) did not retrieve their prescription again upon subsequent consultation. A higher proportion of male patients repeatedly failed to retrieve their medication, compared with female patients (55% vs 38%; P=0.028). There were no statistically significant differences in the age of patients, and the period of their non-retrieved prescription. There was also no difference in the complexity of the drug regime between repeated non-retrievers compared with non-recurring non-retrievers; in both cases, the mean number of medication prescribed to them were around 2. Patients who failed to retrieve their medication before were likely to not retrieve their medication again (P=0.000). Psychiatrists’ actions following a patient’s failure to retrieve medication play an important role in reducing the recurrence of medication non-retrieval. Patients whose failure to retrieve their medication was acknowledged by their doctors, discussed in their next consultation, with adjustment to their drug regime, were associated with a higher propensity to retrieve their medication subsequently (P=0.003, 0.000 and 0.000 respectively). Follow up that was advanced subsequent to a patient’s failure to retrieve their medication was also associated with a lower recurrence rate, regardless of whether the change in appointment was initiated by the patient or the doctor (P=0.017).