Why Don't Many ER Patients Pick Up Their Prescriptions After Being Discharged?

People rarely do things unless they really have to. The truth is we tend to be a bit lazy and if we think something isn’t important then we won’t put any effort into it. Sometimes we do think something is important, but we postpone it or we forget about it altogether. One example is voting. A lot of people spend weeks advocating for a candidate and becoming fully dedicated to the process, but eventually they just neglect voting. They’re either busy or they just get lazy. People, regardless of where they come from or how they were raised, usually need to be nudged into doing things.

We all have someone in our lives for example who can get sick and neglect going to the doctor. You have to keep pushing them until they do. They usually listen to you after constant nagging and accept to go begrudgingly. A popular example of this in healthcare is that people who visit ERs usually don’t pick up their prescriptions. There are lots of factors involved here such as health literacy and financial restraints, but even when these are taken away the issue persists. This is a problem that needs to be addressed because there can be health consequences for the person not receiving the treatment they should.

Of course one of the reasons this happens is because of health literacy. It’s the same with patient compliance. If you don’t explain to a hypertensive the importance of taking their medication strictly then they might neglect it completely. This is very true in a disease like hypertension where the patient rarely has an actual complaint and the hypertension is discovered accidentally. It makes sense that people won’t put in the effort if they’re not told why they should take the time to do so. Another problem that gets in the way of picking up ER prescriptions is a patient’s financial situation. If the drugs are too expensive and aren’t covered by insurance then it’s highly unlikely that a patient will pay for them. Let’s not forget that the ER visit itself probably cost a lot as well.

So, yes, finances and poor health literacy are definitely factors but they’re not the major ones. A study that has been performed in a hospital where almost all of the patients have full health insurance shows that people were still unlikely to pick up their treatment while leaving. This proves that despite having the insurance to get the treatment and the health literacy to understand the importance of doing so, most people still didn’t comply with their doctor's orders. The issue here is called action-intention gap, which is a phenomenon observed in many aspects of everyday life and not restricted to medicine and healthcare. It says that patients do intend to receive their prescription while being discharged, but they just never get around to doing so. Basically you intend to do something, regardless of what it is, but you have a problem following up those intentions with actions. This applies to the voting ordeal we talked about earlier.

Taking your prescription upon being discharged is essential as not doing so can have severe consequences. A lot of ER visits are due to accidents and trauma. If there’s a deep or wide wound then the introduction of infection through that wound could lead to sepsis and even death. It might be necessary for a patient to keep taking antibiotics even after discharge. Failure to fill out that prescription will increase their risk of a potentially lethal infection. Additionally, children who have gastroenteritis may be first admitted to the ER due to dehydration or because of excessive diarrhea. Not all cases will have to be admitted and some of them may be discharged on a certain prescription that ensures they don’t become dehydrated. Most cases of gastroenteritis don’t require antibiotics so waiting for the body to clear the gastroenteritis on its own is best, but while that happens it’s absolutely necessary to prevent dehydration.

Patients need to understand that being discharged doesn’t mean that they’re one hundred percent healthy and are ready to go back to their everyday lives. Sometimes the condition is not severe enough for them to remain in the hospital which is inconvenient to them, expensive, and adds to their risk of hospital acquired infections. If a doctor discharges you but prescribes a certain drug, then you must take that drug. Actually, patients who don’t pick up their prescription on discharge are very likely to be readmitted again pretty soon. One of the most common causes of these readmissions is infections.

There’s really no impact on pharmacies if a prescription isn’t picked up. After a certain period of time the drug is relabeled and put back on the shelf to wait for the next time it’s ordered. So the drugs don’t go to waste. As for payment and insurance companies, if a drug isn’t picked up then the order is cancelled and the insurance company is no longer charged for it.

Overcoming this issue isn’t easy but it’s not so hard either. Doctors can first start by making sure patients understand their condition and why these drugs are prescribed. Explain to your trauma patient that not taking antibiotics can lead to a severe infection which could be potentially fatal. At the same time explain to the parents of a child with gastroenteritis the importance of adequate and proper hydration. No father or mother will neglect the prescribed treatment when they realize the risk involved in not giving it to their child. Sadly there’s not much to do about financial issues. If a patient isn’t covered then you can’t force them to get the treatment. It’s their decision, but you need to make sure they understand the full consequences if they choose to not follow your plan. Explaining that they only need to take this drug for a few days and therefore won’t have to keep buying it may help ease them into getting it.

Despite all of that, we mentioned that the issue is often behavioral. A patient intends to follow your orders, but doesn’t, and the reason is neither financial nor a lack of understanding. There is one successful method that has been used to eliminate the action-intention gap and it has been used for political reasons. In the 2008 elections, a team managed to increase the turnout of Democratic voters by calling them and discussing three issues: what time they would vote, where they would be coming from, and what they would be doing beforehand.

This technique can be implemented in medicine. While discharging a patient you can ask them when they would pick up their treatment, where would they be coming from, and what would they be doing beforehand. That way you’re already creating a plan for them and there’s very little left for them to do. They just need to follow that plan and they’ll get the prescription. Another option is to have someone from the hospital or pharmacy call patients who don’t pick up their treatments to remind them. Maybe they just forgot on their way out.

Most people aren’t very proactive. We can be very negligent especially when it comes to our health. We get sick we think it’s just a cold and it’ll go away in a few days. Our leg hurts we assume we must have bumped it against something and the pain will go away soon. We rarely take any action to improve our health, especially doing things like going to the doctor, unless our loved ones keep pushing us to do so. People need to understand the importance of complying with their doctor’s orders upon discharge. A doctor won’t prescribe drugs unnecessarily and any prescription written is one that is definitely needed. Doctors need to make sure patients do what they’re supposed to and what they agreed to.