1. Medication Noncompliance among Elderly Emergency Department Patients Steven Kleinman, Department of Biology, York College; Steven Mooth, Marc Pollack, Amy Daugherty, Emergency Department, York Hospital, York PA Introduction  Medication compliance can be defined as the extent to which a person’s medication taking behavior coincides with medical advice. There are many factors affecting compliance which include forgetting, misunderstanding of the directions, feeling better or worse, and cost related reasons.  The elderly make up a large portion of the population who regularly take prescribed medications. The factor most affecting medication compliance among this group is cost.  Prescription drug costs are on the rise and are doing so faster than the Consumer Price Index which creates a problem for those on a fixed income.  Medicare Part D is a government program that was recently established to help pay for the costs of prescription medications for those currently covered by Medicare most of whom are elderly. Objectives The objectives of this study were to determine if elderly emergency department patients are noncompliant for financial reasons and the impact of Medicare Part D on compliance and cost. Hypotheses  The number of noncompliant patients enrolled in the Medicare Part D program would be much less than those who are not enrolled  Those who are noncompliant would have generally greater out of pocket expenses than those who were compliant Sample Survey Questions: 1. In the past month, what were your out-of-pocket medication expenses? □ No charge□ $150 to $199 □ $1 to $49□ $200 to $299 □ $50 to $99□ $300+ □ $100 to $149 2. During the past year have you for any reason skipped taking your medication? □ Yes, often □ Yes, occasionally □ No 3. Do you have drug coverage insurance or another program that helps pay for your prescription medications? □ Private Insurance □ Medicare Part D □ Prescription Assistance Program □ PACE/PACENET □ Other ____________________ □ None Methods Patient with bed in Emergency Department Inclusion Criteria: 65+ years old, English speaking, not critically ill, no altered mental status or consciousness No further action taken Verbal and written consent from patient for participation in survey N=500 Recorded as non-participant N=136 Survey administered to patient N=364 Chart review of Emergency Department encounter NoYes NoYes Results Conclusions  There is no significant statistical difference between the numbers of noncompliant patients enrolled in Medicare Part D and those who are not.  Those patients who are noncompliant generally have a greater monthly out-of-pocket cost for medications than those who are compliant. Patient Characteristics Average Age76.6 Average Number of Medications6.3 % Male51.1 % Enrolled in Medicare Part D 50.1 % Noncompliant10.2 Figure 1. Percentage of compliant and noncompliant patients who are enrolled in Medicare Part D. MPD represents those who are enrolled in Medicare Part D and no MPD represents those who are not. Percentages are based on cross tabulations of members in each category. Figure 2. Monthly out of pocket medication expenses for both MPD and non-MPD patients who are compliant and noncompliant. Percentages are based on cross tabulations of members in each category. Figure 3. Monthly out of pocket medication expenses for both compliant and noncompliant patients who are enrolled in Medicare Part D and those who are not. MPD represents those who are enrolled in Medicare Part D and no MPD represents those who are not. Percentages are based on cross tabulations of members in each category. Acknowledgements I would like to thank Dr. Bradley Rehnberg for his assistance and guidance throughout the course of this project. I would also like to thank the students of Emergency Grand Rounds I for assisting in the data collection process.