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Primary Medication Non-Adherence: Analysis of 195,930 Electronic Prescriptions

ABSTRACT

BACKGROUND

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.

OBJECTIVE

Evaluate primary non-adherence in community-based practices and identify predictors of non-adherence.

PARTICIPANTS

75,589 patients treated by 1,217 prescribers in the first year of a community-based e-prescribing initiative.

DESIGN

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.

MAIN MEASURES

Primary medication non-adherence.

KEY RESULTS

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%).

CONCLUSIONS

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.

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References

  1. Burwen DR, Galusha DH, Lewis JM, et al. National and state trends in quality of care for acute myocardial infarction between 1994-1995 and 1998-1999: the medicare health care quality improvement program. Arch Intern Med. 2003;163:1430–9.

    Article  PubMed  Google Scholar 

  2. Ganz DA, Glynn RJ, Mogun H, et al. Adherence to guidelines for oral anticoagulation after venous thrombosis and pulmonary embolism. J Gen Intern Med. 2000;15:776–81.

    Article  CAS  PubMed  Google Scholar 

  3. 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  Google Scholar 

  4. Jencks SF, Huff ED, Cuerdon T. Change in the quality of care delivered to Medicare beneficiaries, 1998-1999 to 2000-2001. JAMA. 2003;289:305–12.

    Article  PubMed  Google Scholar 

  5. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635–45.

    Article  PubMed  Google Scholar 

  6. Shrank WH, Asch SM, Adams J, et al. The quality of pharmacologic care for adults in the United States. Med Care. 2006;44:936–45.

    Article  PubMed  Google Scholar 

  7. Benner J, Glynn R, Mogun H, Neumann P, Weinstein M, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA. 2002;288:455–61.

    Article  PubMed  Google Scholar 

  8. 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.

    CAS  PubMed  Google Scholar 

  9. O’Connor PJ. Improving medication adherence: challenges for physicians, payers, and policy makers. Arch Int Med. 2006;166:1802–4.

    Article  Google Scholar 

  10. Osterberg L, Blaschke T. Drug therapy-adherence to medication. N Engl J Med. 2005;353(5):487–97.

    Article  CAS  PubMed  Google Scholar 

  11. Partridge A, Wang P, Winer E, Avorn J. Non-adherence to adjuvant tamoxifen therapy in women with primary breast cancer. J Clin Oncol. 2003;21:602–6.

    Article  CAS  PubMed  Google Scholar 

  12. Partridge AH, Avorn J, Wang PS, Winer EP. Adherence to therapy with oral antineoplastic agents. J Natl Cancer Inst. 2002;94:652–61.

    PubMed  Google Scholar 

  13. Siegel D, Lopez J, Meier J. Antihypertensive medication adherence in the department of veterans affairs. Am J Med. 2007;120:26–32.

    Article  PubMed  Google Scholar 

  14. Ho PM, Rumsfeld JS, Masoudi FA, et al. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med. 2006;166:1836–41.

    Article  PubMed  Google Scholar 

  15. Ho PM, Spertus JA, Masoudi FA, et al. Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med. 2006;166:1842–7.

    Article  PubMed  Google Scholar 

  16. Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005;43:521–30.

    Article  PubMed  Google Scholar 

  17. Caro JJ, Salas M, Speckman JL, Raggio G, Jackson JD. Persistence with treatment for hypertension in actual practice. CMAJ. 1999;160(1):31–7.

    CAS  PubMed  Google Scholar 

  18. Enhancing Prescription Medicine Adherence: A National Action Plan. 2007. (Accessed January 5, 2010, at http://www.talkaboutrx.org/documents/enhancing_prescription_medicine_adherence.pdf. .)

  19. World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: WHO; 2003.

    Google Scholar 

  20. Andrade SE, Kahler KH, Frech F, Chan KA. Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf. 2006;15:565–74.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  CAS  Google Scholar 

  22. Ekedahl A, Mansson N. Unclaimed prescriptions after automated prescription transmittals to pharmacies. Pharm World Sci. 2004;26:26–31.

    Article  PubMed  Google Scholar 

  23. Wamala S, Merlo J, Bostrom G, Hogstedt C, Agren G. Socioeconomic disadvantage and primary non-adherence with medication in Sweden. Int J Qual Health Care. 2007;19:134–40.

    Article  PubMed  Google Scholar 

  24. Wroth TH, Pathman DE. Primary medication adherence in a rural population: the role of the patient-physician relationship and satisfaction with care. J Am Board Fam Med. 2006;19:478–86.

    Article  PubMed  Google Scholar 

  25. 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.

  26. Shah NR, Hirsch AG, Zacker C, Taylor S, Wood GC, Stewart W. Factors associated with first-fill adherence rates for diabetic medications: a cohort study. J Gen Intern Med. 2008;24:233–7.

    Article  PubMed  Google Scholar 

  27. Shah NR, Hirsch AG, Zacker C, et al. Predictors of first-fill adherence for patients with hypertension. Am J Hypertens. 2009;22:392–6.

    Article  PubMed  Google Scholar 

  28. Lapane KL, Dubé C, Schneider KL, Quilliam BJ. Patient perceptions regarding electronic prescriptions: is the geriatric patient ready? J Am Geriatr Soc. 2007;55:1254–9.

    Article  PubMed  Google Scholar 

  29. Fischer MA, Stedman MR, Vogeli C, Ferris TG, Weissman JS. Uptake of electronic prescribing in community-based practices. J Gen Intern Med. 2008;23:358–63.

    Article  PubMed  Google Scholar 

  30. 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

  31. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. JAMA. 2003;289(19):2560–72.

    Article  CAS  PubMed  Google Scholar 

  32. Jackevicius CA, Li P, Tu JV. Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction. Circulation. 2008;117(8):1028–36.

    Article  PubMed  Google Scholar 

  33. Solomon MD, Goldman DP, Joyce GF, Escarce JJ. Cost sharing and the initiation of drug therapy for the chronically Ill. Arch Intern Med. 2009;169(8):740–8.

    Article  PubMed  Google Scholar 

  34. 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.

    Article  Google Scholar 

  35. Shrank WH, Fox SA, Kirk A, et al. The effect of pharmacy benefit design on patient-physician communication about costs. J Gen Intern Med. 2006;21:334–9.

    Article  PubMed  Google Scholar 

  36. 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.

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Acknowledgements

We acknowledge the assistance of BCBSMA, Tufts HP, and ZixCorp in providing data. The investigators retained control over all aspects of the analyses and presentation of results.

The research was supported by AHRQ grant R01 HS15175.

Dr. Brookhart is supported by a career development grant from NIH (AG12084).

Dr. Shrank is supported by a career development grant from NIH (HL090505).

Conflict of Interest

None disclosed.

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Correspondence to Michael A. Fischer MD, MS.

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Fischer, M.A., Stedman, M.R., Lii, J. et al. Primary Medication Non-Adherence: Analysis of 195,930 Electronic Prescriptions. J GEN INTERN MED 25, 284–290 (2010). https://doi.org/10.1007/s11606-010-1253-9

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  • DOI: https://doi.org/10.1007/s11606-010-1253-9

KEY WORDS

  • adherence
  • non-adherence
  • electronic prescribing
  • health information technology