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European Journal of Clinical Pharmacology

, Volume 70, Issue 6, pp 757–763 | Cite as

Primary non-adherence in general practice: a Danish register study

  • Anton PottegårdEmail author
  • Rene dePont Christensen
  • Alae Houji
  • Camilla Binderup Christiansen
  • Maja Skov Paulsen
  • Janus Laust Thomsen
  • Jesper Hallas
Pharmacoepidemiology and Prescription

Abstract

Purpose

The aim of this study was to describe primary non-adherence (PNA) in a Danish general practitioner (GP) setting, i.e. the extent to which patients fail to fill the first prescription for a new drug. We also assessed the length of time between the issuing of a prescription by the GP and the dispensing of the drug by the pharmacist. Lastly, we sought to identify associations between PNA and the characteristics of the patient, the drug and the GP.

Methods

By linking data on issued prescriptions compiled in the Danish General Practice Database with data on redeemed prescriptions contained in the Danish National Prescription Registry, we calculated the rate of PNA among Danish patients from January 2011 through to August 2012. Characteristics associated with PNA were analysed using a mixed effects logistic regression model.

Results

A total of 146,959 unique patients were started on 307,678 new treatments during the study period. The overall rate of PNA was 9.3 %, but it varied according to the major groups of the Anatomical Therapeutic Chemical (ATC) Classification System, ranging from 16.9 % for “Blood and bloodforming organs” (ATC group B) to 4.7 % for “Cardiovascular system” (ATC group C). Most of the patients redeemed their prescriptions within the first week. Older age, high income and a diagnosis of chronic obstructive pulmonary disease were found to be significantly associated with lower rates of PNA, while polypharmacy and a diagnosis of ischaemic heart disease were associated with higher rates of PNA.

Conclusions

The overall rate of PNA among Danish residents in a GP setting was 9.3 %. Certain drug classes and patient characteristics were associated with PNA.

Keywords

Patient adherence Medication adherence General practice Registries Pharmacology Pharmacoepidemiology 

Notes

Conflicts of interest

None.

References

  1. 1.
    DiMatteo MR (2004) Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care 42(3):200–209PubMedCrossRefGoogle Scholar
  2. 2.
    Raebel MA, Carroll NM, Ellis JL, Schroeder EB, Bayliss EA (2011) Importance of including early nonadherence in estimations of medication adherence. Ann Pharmacother 45(9):1053–1060PubMedCrossRefGoogle Scholar
  3. 3.
    Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X (2008) Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2:CD000011PubMedGoogle Scholar
  4. 4.
    Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353(5):487–497PubMedCrossRefGoogle Scholar
  5. 5.
    Beardon PH, McGilchrist MM, McKendrick AD, McDevitt DG, MacDonald TM (1993) Primary non-compliance with prescribed medication in primary care. BMJ 307(6908):846–848PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Ax F, Ekedahl A (2010) Electronically transmitted prescriptions not picked up at pharmacies in Sweden. Res Soc Adm Pharm 6(1):70–77CrossRefGoogle Scholar
  7. 7.
    Ekedahl A, Månsson N (2004) Unclaimed prescriptions after automated prescription transmittals to pharmacies. Pharm World Sci 26(1):26–31PubMedCrossRefGoogle Scholar
  8. 8.
    Fallis BA, Dhalla IA, Klemensberg J, Bell CM (2013) Primary medication non-adherence after discharge from a general internal medicine service. PLoS One 8(5):e61735PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Fischer MA, Choudhry NK, Brill G, Avorn J, Schneeweiss S, Hutchins D et al (2011) Trouble getting started: predictors of primary medication nonadherence. Am J Med 124(11):1081, e9–22PubMedCrossRefGoogle Scholar
  10. 10.
    Fischer MA, Stedman MR, Lii J, Vogeli C, Shrank WH, Brookhart MA et al (2010) Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med 25(4):284–290PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Hagström B, Mattsson B, Rost I-M, Gunnarsson RK (2004) What happened to the prescriptions? A single, short, standardized telephone call may increase compliance. Fam Pract 21(1):46–50PubMedCrossRefGoogle Scholar
  12. 12.
    Jackevicius CA, Li P, Tu JV (2008) Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction. Circulation 117(8):1028–1036PubMedCrossRefGoogle Scholar
  13. 13.
    Kennedy J, Tuleu I, Mackay K (2008) Unfilled prescriptions of medicare beneficiaries: prevalence, reasons, and types of medicines prescribed. J Manag Care Pharm 14(6):553–560PubMedGoogle Scholar
  14. 14.
    Linnet K, Halldórsson M, Thengilsdóttir G, Einarsson ÓB, Jónsson K, Almarsdóttir AB (2013) Primary non-adherence to prescribed medication in general practice: lack of influence of moderate increases in patient copayment. Fam Pract 30(1):69–75PubMedCrossRefGoogle Scholar
  15. 15.
    Matsui D, Joubert GI, Dykxhoorn S, Rieder MJ (2000) Compliance with prescription filling in the pediatric emergency department. Arch Pediatr Adolesc Med 154(2):195–198PubMedCrossRefGoogle Scholar
  16. 16.
    Shin J, McCombs JS, Sanchez RJ, Udall M, Deminski MC, Cheetham TC (2012) Primary nonadherence to medications in an integrated healthcare setting. Am J Manag Care 18(8):426–434PubMedGoogle Scholar
  17. 17.
    Storm A, Andersen SE, Benfeldt E, Serup J (2008) One in 3 prescriptions are never redeemed: primary nonadherence in an outpatient clinic. J Am Acad Dermatol 59(1):27–33PubMedCrossRefGoogle Scholar
  18. 18.
    Wamala S, Merlo J, Bostrom G, Hogstedt C, Agren G (2007) Socioeconomic disadvantage and primary non-adherence with medication in Sweden. Int J Qual Health Care 19(3):134–140PubMedCrossRefGoogle Scholar
  19. 19.
    Wroth TH, Pathman DE (2006) Primary medication adherence in a rural population: the role of the patient-physician relationship and satisfaction with care. J Am Board Fam Med JABFM 19(5):478–486CrossRefGoogle Scholar
  20. 20.
    Pedersen KM, Andersen JS, Søndergaard J (2012) General practice and primary health care in Denmark. J Am Board Fam Med JABFM 25[Suppl 1]:S34–S38CrossRefGoogle Scholar
  21. 21.
    Paulsen MS, Andersen M, Thomsen JL, Schroll H, Larsen PV, Lykkegaard J et al (2013) Multimorbidity and blood pressure control in 37 651 hypertensive patients from Danish general practice. J Am Heart Assoc 2(1):e004531PubMedCentralGoogle Scholar
  22. 22.
    Schroll H, Christensen RD, Thomsen JL, Andersen M, Friborg S, Søndergaard J (2012) The danish model for improvement of diabetes care in general practice: impact of automated collection and feedback of patient data. Int J Fam Med 2012:208123Google Scholar
  23. 23.
    World Health Organization (WHO) Collaborating Centre for Drug Statistics Methodology (2012) Guidelines for ATC classification and DDD assignment 2013. WHO Collaborating Centre for Drug Statistics Methodology, Norwegian Institute of Public Health, OsloGoogle Scholar
  24. 24.
    Kildemoes HW, Sørensen HT, Hallas J (2011) The Danish National Prescription Registry. Scand J Public Health 39[7 Suppl]:38–41PubMedCrossRefGoogle Scholar
  25. 25.
    Pedersen CB (2011) The Danish Civil Registration System. Scand J Public Health 39[7 Suppl]:22–25PubMedCrossRefGoogle Scholar
  26. 26.
    Jensen VM, Rasmussen AW (2011) Danish Education Registers. Scand J Public Health 39[7 Suppl]:91–94PubMedCrossRefGoogle Scholar
  27. 27.
    Baadsgaard M, Quitzau J (2011) Danish registers on personal income and transfer payments. Scand J Public Health 39[7 Suppl]:103–105PubMedCrossRefGoogle Scholar
  28. 28.
    Greenland S (1996) Confounding and exposure trends in case-crossover and case-time-control designs. Epidemiology 7(3):231–239PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Anton Pottegård
    • 1
    • 2
    Email author
  • Rene dePont Christensen
    • 1
    • 3
  • Alae Houji
    • 1
  • Camilla Binderup Christiansen
    • 1
  • Maja Skov Paulsen
    • 3
    • 4
  • Janus Laust Thomsen
    • 3
    • 4
  • Jesper Hallas
    • 1
    • 2
  1. 1.Clinical Pharmacology, Institute of Public HealthUniversity of Southern DenmarkOdense CDenmark
  2. 2.Department of Clinical Chemistry & PharmacologyOdense University HospitalOdense CDenmark
  3. 3.Research Unit of General Practice, Institute of Public HealthUniversity of Southern DenmarkOdense CDenmark
  4. 4.Danish Quality Unit of General PracticeOdense CDenmark

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