Primary non-adherence to bisphosphonates in an integrated healthcare setting
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We estimated primary non-adherence to oral bisphosphonate medication and examined the factors associated with primary non-adherence. Nearly 30 % of women did not pick up their new bisphosphonate within 60 days. Identifying barriers and developing interventions that address patients’ needs and concerns at the time a new medication is prescribed are warranted.
To estimate primary non-adherence to oral bisphosphonate medications using electronic medical record data in a large, integrated healthcare delivery system and to describe patient and prescribing provider factors associated with primary non-adherence.
Women aged 55 years and older enrolled in Kaiser Permanente Southern California (KPSC) with a new prescription for oral bisphosphonates between December 1, 2009 and March 31, 2011 were identified. Primary non-adherence was defined as failure to pick up the new prescription within 60 days of the order date. Multivariable logistic regression models were used to investigate patient factors (demographics, healthcare utilization, and health conditions) and prescribing provider characteristics (demographics, years in practice, and specialty) associated with primary non-adherence.
We identified 8,454 eligible women with a new bisphosphonate order. Among these women, 2,497 (29.5 %) did not pick up their bisphosphonate prescription within 60 days of the order date. In multivariable analyses, older age and emergency department utilization were associated with increased odds of primary non-adherence while prescription medication use and hospitalizations were associated with lower odds of primary non-adherence. Prescribing providers practicing 10 or more years had lower odds of primary non-adherent patients compared with providers practicing less than 10 years. Internal medicine and rheumatology providers had lower odds of primary non-adherent patients than primary care providers.
This study found that nearly one in three women failed to pick up their new bisphosphonate prescription within 60 days. Identifying barriers and developing interventions aimed at reducing the number of primary non-adherent patients to bisphosphonate prescriptions are warranted.
KeywordsAdherence Bisphosphonates Postmenopausal osteoporosis Primary non-adherence
This study was funded by a contractual agreement between Kaiser Permanente Southern California and Amgen Inc., Thousand Oaks, CA.
Conflicts of interest
Dr. O’Malley is an employee of Amgen Inc. and owns stock in Amgen Inc. Drs. Muntner, Gold, Silverman, and Morisky have served as advisors for Amgen Inc. Drs. Muntner, Gold and Silverman have served as consultants for Amgen Inc. Drs. Reynolds and Muntner received research support from Amgen Inc. Dr. Silverman has served as an advisor for Lilly, Novartis and Pfizer/Wyeth. Dr. Silverman has served as a consultant for Genentech, Lilly, Novartis and Pfizer/Wyeth. Dr. Silverman has received research support from Lilly and Pfizer/Wyeth. This study was funded by a contractual agreement between Kaiser Permanente Southern California and Amgen Inc., Thousand Oaks, CA.
- 9.Hosmer DW, Lemeshow S (1989) Applied logistic regression. John Wiley & Sons, New YorkGoogle Scholar
- 12.Raebel MA, Ellis JL, Carroll NM, Bayliss EA, McGinnis B, Schroeder EB, Shetterly S, Xu S, Steiner JF (2012) Characteristics of patients with primary non-adherence to medications for hypertension, diabetes, and lipid disorders. J Gen Intern Med 27:57–64. doi: 10.1007/s11606-011-1829-z PubMedCrossRefGoogle Scholar
- 15.Liberman JN, Hutchins DS, Popiel RG, Patel MH, Jan SA, Berger JE (2010) Determinants of primary nonadherence in asthama-controller and dyslipidemia pharmacotherapy. Am J Pharm Benefits 2:111–118Google Scholar
- 16.Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X (2008) Interventions for enhancing medication adherence. Cochrane database of systematic reviews CD000011. doi: 10.1002/14651858.CD000011.pub3
- 17.Derose SF, Green K, Marrett E, Cheetham TC, Chiu VY, Harrison TN, Reynolds K, Vansomphone SS, Scott RD (2012) Automated outreach to increase primary adherence to cholesterol-lowering medications. Arch Intern Med Published online: doi: 10.1001/2013.jamainternmed.717