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.

SUBMITTER: Fischer MA 

PROVIDER: S-EPMC2842539 | biostudies-literature | 2010 Apr

REPOSITORIES: biostudies-literature