Medication use in the acute setting: self-reported adherence and awareness and application of sick day rules at the emergency department

Posted on 12 Dec 2025 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.176555532.25203623/v1 — This is a preprint and has not been peer-reviewed. Data may be preliminary. Medication use in the acute setting: self-reported adherence and awareness and application of sick day rules at the emergency department Soha Saleh 1, Jonne J. Sikkens 2, Wilmar M. Charmant 2, Marieke J.A. de Regt 1, and Eric Franssen1 1OL VG 2Amsterdam UMC Locatie AMC December 12, 2025 Abstract Aim: Polypharmacy patients are highly susceptible to drug-related problems during acute illness, such as acute kidney injury, hypotension, and falls. Temporary discontinuation of certain medications according to sick-day rules mitigate these risks. However, little is known about real-world medication management in emergency care. This study aimed to assess medication adherence, medication knowledge, and the application of sick-day rules among internal medicine patients presenting to the emergency department (ED). Methods: We conducted a prospective, interview-based study among patients presenting to the emergency department (ED) from January to September 2024. Patients using [?]5 regular medications and presenting for internal medicine were included. The questionnaire assessed self-reported medication adherence (using MARS-5), medication knowledge, and sick day rules application. Results: 83 patients were included (median age 76 [IQR 68–82] years, 49.4% female). Only 14.5% of patients reported full knowledge of their medications, while 53.0% reported no knowledge. Patients lacking medication knowledge were older (mean age 78.8 ± 7.5 years) than those who with full (67.0 ± 14.0 years) or partial (70.6 ± 15.6 years) knowledge (p = 0.015 and p = 0.016, respectively). Self-reported adherence was high (median MARS-5 score 23 [IQR 21–23]). During acute illness, most patients (62.7%) continued all regular medications. Conclusion: Despite high self-reported adherence, medication knowledge and application of sick day rules were strikingly low. Most patients continued all medications in the 48 hours preceding their emergency department visit. This highlights the urgent need for patient education and guidance to promote safe medication management in adults with polypharmacy. Hosted file 20251211 Application of sick day rules in the acute setting.docx available at https: //authorea.com/users/1009605/articles/1369585-medication-use-in-the-acute-setting-self- reported-adherence-and-awareness-and-application-of-sick-day-rules-at-the-emergency- department 1