Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why don’t patients pick up their prescriptions?

Alister Martin, MD
Physician
March 16, 2016
Share
Tweet
Share

As emergency physicians, we write prescriptions for patients that we discharge home for all manner of presenting complaints. I used to believe that the overwhelming majority of these prescriptions would be filled by the patient after discharge.

It turns out I was wrong.

Research estimates that patients discharged from emergency departments (EDs) fail to pick up their high urgency prescriptions, like antibiotics, nearly 35 percent of the time.

This is problematic because failure to fill high urgency prescriptions has been shown to lead to systemic waste and high individual morbidity, evidenced by higher infection-related rehospitalizations and all-cause rehospitalizations.

So why the low numbers?

The popular belief among experts holds that this discrepancy is mostly due to medication access and affordability constraints, but this may not be the full story.

Consider that, even in Massachusetts, where overall insured rates edge closer to 100 percent and access to care is higher than in most states, the number of failed prescription pick-ups mirrors the rest of the nation. In fact, a recent study among pediatric patients in a Boston emergency department found that 32 percent of families did not fill prescriptions for their child after a pediatric ED visit.

Moreover, that same study found no association between low health literacy, access to a primary care doctor, or affordability of the prescription, on whether or not a family would pick up their child’s prescription.

So to what can we attribute the discrepancy?

Part of the answer may come from the field of behavioral economics.

At discharge, most patients fully intend to pick up their prescription, but in practice, many never follow through and make it to the pharmacy. Researchers in behavioral economics who study the science of decision-making call this scenario an action-intention gap.

EDs may be able to do a better job of helping our patients follow through and close these action-intention gaps by adopting strategies from the unlikeliest of places, presidential campaigns.

In that scenario, many potential voters who fully intend to vote never follow through and make it to the voting booth on election day. Campaign strategists have leveraged insights from behavioral economics to close that action-intention gap and increase voter turnout in their candidate’s favor.

In 2008, behavioral economist and Harvard Kennedy School professor, Todd Rogers, set out to test novel interventions focused on increasing voter turnout during the 2008 Democratic Presidential Primary.

His team added an intervention to phone call scripts which were to be read to over 280,000 potential voters by campaign volunteers during standard get out the vote house calls. The call scripts contained messaging designed to remind potential voters about the election and their duty to vote.

ADVERTISEMENT

To this standard script, his team added a simple but powerful behavioral economics intervention called an implementation intention which consisted of three follow-up questions designed to facilitate voting plan making: what time they would vote, where they would be coming from, and what they would be doing beforehand.

Implementation intentions work because we create a cognitive link between an anticipated future situation and the intended behavior by articulating the when, where, and how of following through on an intention. In other words, our plan for following through on a future behavior takes the form “if situation Y, then trigger behavior X.”

By creating this link upfront, we can increase the probability that we will follow through on that action.

Figure 1 provides an example of a nudge. A nudge is a concept in behavioral economics which influences an individual’s decision-making in a predictable way by leveraging subconscious processes and without forbidding any options or significantly changing their economic incentives.

Figure 1

Figure 1

Rogers found that by adding this costless nudge to the pre-existing script, his team was able to increase voter turnout by 4.1 percent over the control. To put this effect size into context, in the 2012 presidential election increasing voter turnout among eligible voters by just half that amount for one candidate’s supporters would have changed the outcomes in Florida, Ohio, and North Carolina.

Building on these findings, in the 2010 general election, his team tested another nudge called a threat of accountability, which holds that by subtly reminding an individual that they may be held accountable for following through on a future action, they will be more likely to follow through on that action. By adding the phrase, “We may call you after the election to talk about your voting experience,”  to a piece of standard voter mailing they were able to increase the effectiveness of the mailing in terms of the voting it stimulated by almost half.

Both of these strategies have now become common staples of modern-day campaigns and are being implemented in the 2016 presidential primary race by candidates across the political spectrum.

How could this be applied to help increase prescription pick-up rates?

Imagine, as part of the discharge process, patients were asked a similar battery of questions: What time they will pick up their medication, where they will be beforehand, and how they will get there. This research shows that by weaving simple but validated nudges like this and a threat of accountability into pre-existing practices like patient discharge summaries, EDs may be able to help patients close the action-intention gap and follow through to pick up the medications we prescribe them at zero marginal cost.

The intersection of emergency medicine and behavioral economics is rich terrain for exploration and nudging may yet be the tool that helps us design and integrate a model of care that works best for our patients.

Alister Martin is an emergency medicine resident.

Image credit: Shutterstock.com

Prev

How many more physicians will we lose to suicide?

March 16, 2016 Kevin 14
…
Next

Who do presidential candidates blame for high health costs?

March 16, 2016 Kevin 159
…

Tagged as: Emergency Medicine

Post navigation

< Previous Post
How many more physicians will we lose to suicide?
Next Post >
Who do presidential candidates blame for high health costs?

ADVERTISEMENT

More by Alister Martin, MD

  • We must be committed to putting patients over politics

    Alister Martin, MD

Related Posts

  • Are patients using social media to attack physicians?

    David R. Stukus, MD
  • Here’s why your patients disregard prescriptions

    Kevin R.R. Williams
  • You are abandoning your patients if you are not active on social media

    Pat Rich
  • Physician Suicide Awareness Day: Where are the patients? 

    Jennifer M. Sweeney
  • Is physician shadowing immoral?

    David Penner
  • A love letter to patients

    Marcie Costello

More in Physician

  • How an insider advocate can save a loved one

    Chrissie Ott, MD
  • A powerful story of addiction, strength, and redemption

    Ryan McCarthy, MD
  • Why reforming medical boards is critical to saving patient care

    Kayvan Haddadan, MD
  • Why heart and brain must work together for love

    Felicia Cummings, MD
  • How pain clinics contribute to societal safety

    Olumuyiwa Bamgbade, MD
  • Why frivolous malpractice lawsuits are costing Americans billions

    Howard Smith, MD
  • Most Popular

  • Past Week

    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why physician strikes are a form of hospice

      Patrick Hudson, MD | Physician
    • Private practice employment agreements: What happens if private equity swoops in?

      Dennis Hursh, Esq | Conditions
    • How an insider advocate can save a loved one

      Chrissie Ott, MD | Physician
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • How an insider advocate can save a loved one

      Chrissie Ott, MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • A powerful story of addiction, strength, and redemption

      Ryan McCarthy, MD | Physician
    • An ER nurse explains why the system is collapsing [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why reforming medical boards is critical to saving patient care

      Kayvan Haddadan, MD | Physician
    • How denial of hypertension endangers lives and what doctors can do

      Dr. Aminat O. Akintola | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 19 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why physician strikes are a form of hospice

      Patrick Hudson, MD | Physician
    • Private practice employment agreements: What happens if private equity swoops in?

      Dennis Hursh, Esq | Conditions
    • How an insider advocate can save a loved one

      Chrissie Ott, MD | Physician
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • How an insider advocate can save a loved one

      Chrissie Ott, MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • A powerful story of addiction, strength, and redemption

      Ryan McCarthy, MD | Physician
    • An ER nurse explains why the system is collapsing [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why reforming medical boards is critical to saving patient care

      Kayvan Haddadan, MD | Physician
    • How denial of hypertension endangers lives and what doctors can do

      Dr. Aminat O. Akintola | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why don’t patients pick up their prescriptions?
19 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...