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The validity of self-reported primary adherence among Medicaid patients discharged from the emergency department with a prescription medication.

Abstract：

STUDY OBJECTIVE:We determine the validity of self-reported prescription filling among emergency department (ED) patients. METHODS:We analyzed a subgroup of 1,026 patients enrolled in a randomized controlled trial who were prescribed at least 1 medication at ED discharge, were covered by Medicaid insurance, and completed a telephone interview 1 week after the index ED visit. We extracted all pharmacy and health care use claims information from a state Medicaid database for all subjects within 30 days of their index ED visit. We used the pharmacy claims as the criterion standard and evaluated the accuracy of self-reported prescription filling obtained during the follow-up interview by estimating its sensitivity, specificity, positive likelihood ratio and negative likelihood ratio tests. We also examined whether the accuracy of self-reported prescription filling varied significantly by patient and clinical characteristics. RESULTS:Of the 1,635 medications prescribed, 74% were filled according to the pharmacy claims. Subjects reported filling 90% of prescriptions for a difference of 16% (95% confidence interval [CI] 14% to 18%). The self-reported data had high sensitivity (0.96; 95% CI 0.95 to 0.97) but low specificity (0.30; 95% CI 0.26 to 0.34). The positive likelihood ratio (1.37; 95% CI 1.29 to 2.46) and negative likelihood ratio (0.13; 95% CI 0.09 to 0.17) tests indicate that self-reported data are not a good indicator of prescription filling but are a moderately good indicator of nonfulfillment. Several factors were significantly associated with lower sensitivity (drug class and over-the-counter medications) and specificity (drug class, as needed, site and previous ED use). CONCLUSION:Self-reported prescription filling is overestimated and associated with few factors.

journal_name

Ann Emerg Med

journal_title

Annals of emergency medicine

authors

Ding R,Zeger SL,Steinwachs DM,Ortmann MJ,McCarthy ML

doi

10.1016/j.annemergmed.2013.01.026

subject

Has Abstract

pub_date

2013-09-01 00:00:00

pages

225-34

issue

eissn

0196-0644

issn

1097-6760

pii

S0196-0644(13)00098-X

journal_volume

pub_type

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The validity of self-reported primary adherence among Medicaid patients discharged from the emergency department with a prescription medication.