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. 2010 Apr;25(4):284-90.
doi: 10.1007/s11606-010-1253-9. Epub 2010 Feb 4.

Primary medication non-adherence: analysis of 195,930 electronic prescriptions

Michael A Fischer  1 , Margaret R Stedman, Joyce Lii, Christine Vogeli, William H Shrank, M Alan Brookhart, Joel S Weissman
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Primary medication non-adherence: analysis of 195,930 electronic prescriptions

Michael A Fischer et al. J Gen Intern Med. 2010 Apr.

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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Figure 1
Primary non-adherence to newly prescribed medications. Patients aged 19 and over.
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