Date: 04 Feb 2010
Primary Medication Non-Adherence: Analysis of 195,930 Electronic Prescriptions
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Non-adherence to essential medications represents an important public health problem. Little is known about the frequency with which patients fail to fill prescriptions when new medications are started (“primary non-adherence”) or predictors of failure to fill.
Evaluate primary non-adherence in community-based practices and identify predictors of non-adherence.
75,589 patients treated by 1,217 prescribers in the first year of a community-based e-prescribing initiative.
We compiled all e-prescriptions written over a 12-month period and used filled claims to identify filled prescriptions. We calculated primary adherence and non-adherence rates for all e-prescriptions and for new medication starts and compared the rates across patient and medication characteristics. Using multivariable regressions analyses, we examined which characteristics were associated with non-adherence.
Primary medication non-adherence.
Of 195,930 e-prescriptions, 151,837 (78%) were filled. Of 82,245 e-prescriptions for new medications, 58,984 (72%) were filled. Primary adherence rates were higher for prescriptions written by primary care specialists, especially pediatricians (84%). Patients aged 18 and younger filled prescriptions at the highest rate (87%). In multivariate analyses, medication class was the strongest predictor of adherence, and non-adherence was common for newly prescribed medications treating chronic conditions such as hypertension (28.4%), hyperlipidemia (28.2%), and diabetes (31.4%).
Many e-prescriptions were not filled. Previous studies of medication non-adherence failed to capture these prescriptions. Efforts to increase primary adherence could dramatically improve the effectiveness of medication therapy. Interventions that target specific medication classes may be most effective.
Preliminary versions of this research were presented at the Society of General Internal Medicine Annual Meeting, Pittsburgh, PA, April, 10, 2008, and the International Conference on Pharmacoepidemiology, Copenhagen, Denmark, August 18, 2008.
Higashi T, Shekelle PG, Solomon DH, et al. The quality of pharmacologic care for vulnerable older patients. Ann Intern Med. 2004;140:714–20.PubMed
Matsui D, Joubert G, Dykxhoorn S, Rieder M. Compliance with prescription filling in the pediatric emergency department. Arch Pediatr Adolesc Med. 2000;154(2):195–8.PubMed
O’Connor PJ. Improving medication adherence: challenges for physicians, payers, and policy makers. Arch Int Med. 2006;166:1802–4.CrossRef
Partridge AH, Avorn J, Wang PS, Winer EP. Adherence to therapy with oral antineoplastic agents. J Natl Cancer Inst. 2002;94:652–61.PubMed
Caro JJ, Salas M, Speckman JL, Raggio G, Jackson JD. Persistence with treatment for hypertension in actual practice. CMAJ. 1999;160(1):31–7.PubMed
Enhancing Prescription Medicine Adherence: A National Action Plan. 2007. (Accessed January 5, 2010, at http://www.talkaboutrx.org/documents/enhancing_prescription_medicine_adherence.pdf. .)
World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: WHO; 2003.
Beardon PHG, McGilchrist MM, McKendrick AD, McDevitt DG, MacDonald TM. Primary non-compliance with prescribed medication in primary care. Br Med J. 1993;307(6908):846–8.CrossRef
Bell DS, Marken RS, Meili RC, et al. Recommendations for comparing electronic prescribing systems: results of an expert consensus process. Health Affairs 2004;Jan-Jun;Suppl Web Exclusives:W4-305-17.
Total prevalence of diabetes in the United States, all ages, 2005. 2005. (Accessed January 5, 2010, at http://www.cdc.gov/diabetes/pubs/estimates05.htm#prev, at
Shrank WH, Hoang T, Ettner SL, et al. The implications of choice: prescribing generic or preferred pharmaceuticals improves medication adherence for chronic conditions. Arch Int Med. 2006;166:332–7.CrossRef
Barbaro M, Abelson R. Relief for Some but Maybe Not Many in Wal-Mart Plan for $4 Generic Drugs The New York Times 2006 September 22, 2006.
- Primary Medication Non-Adherence: Analysis of 195,930 Electronic Prescriptions
Journal of General Internal Medicine
Volume 25, Issue 4 , pp 284-290
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- Print ISSN
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- electronic prescribing
- health information technology
- Industry Sectors
- Author Affiliations
- 1. Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, USA
- 2. Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA