Impact of Medication Adherence on Emergency Department Visits in Patients with COPD in a Single Tertiary Hospital in Saudi Arabia

Samah Alshehri, Mohannad Alshibani Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Samah Alshehri, Department of Pharmacy Practice, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589, Saudi Arabia, Tel +966564362332, Fax +12 9666400000. Ext. 20675, Email salshehri1@kau.edu.saIntroduction: There is a very limited information and studies on the impact of adherence to chronic obstructive pulmonary disease (COPD) medications in Saudi Arabia. We hypothesized that the adherence to COPD medication in our tertiary hospital is poor and can lead to frequent ED visits and longer hospitalization stays. The purpose of this study was to assess the impact of medication adherence in patients with COPD on emergency department (ED) visits and hospitalization.Methods: A single-center retrospective observational study included patients with a COPD exacerbation, who were admitted to a tertiary teaching hospital in Jeddah, Saudi Arabia from October 2017 to November 2020. The primary outcome was the rate of emergency department (ED) visit in one year. Secondary outcomes were hospitalization after ED visit and total hospital length of stay. Medication adherence was evaluated by using Fixed Medication Possession Ratio (FMPR). Patients with score of ≥ 0.80 were classified as high-adherent groups while patients with ratio < 0.80 were on low-adherent groups.Results: A total of 266 patients enrolled in the study. Of those 266 patients, 139 patients were on high-adherent group and 127 were on low-adherent group. There was a significant difference between the high-adherent group and low-adherent group in the incidence of ED visit in one year 62 (44.6%) vs 73 (57.5%); P < 0.036, and hospitalization after the ED visit 26 (18.7%) vs 42 (33.1%); P = 0.007. However, there was no significant difference between the two groups in the total hospital length of stay.Conclusion: Among patients with COPD, there was a significant increase in ED visit per one year that leads to more hospitalization among patients with low adherence compared to patients with high adherence. This study highlights the importance of improving the medication adherence in patients with COPD.Keywords: COPD, adherence, ED visit, inhaler