Initiation and Single Dispensing in Cardiovascular and Insulin Medications: Prevalence and Explanatory Factors

Int J Environ Res Public Health. 2020 May 12;17(10):3358. doi: 10.3390/ijerph17103358.


Background: Adherence problems have negative effects on health, but there is little information on the magnitude of non-initiation and single dispensing.

Objective: The aim of this study was to estimate the prevalence of non-initiation and single dispensation and identify associated predictive factors for the main treatments prescribed in Primary Care (PC) for cardiovascular disease (CVD) and diabetes.

Methods: Cohort study with real-world data. Patients who received a first prescription (2013-2014) for insulins, platelet aggregation inhibitors, angiotensin-converting enzyme inhibitors (ACEI) or statins in Catalan PC were included. The prevalence of non-initiation and single dispensation was calculated. Factors that explained these behaviours were explored.

Results: At three months, between 5.7% (ACEI) and 9.1% (antiplatelets) of patients did not initiate their treatment and between 10.6% (statins) and 18.4% (ACEI) filled a single prescription. Body mass index, previous CVD, place of origin and having a substitute prescriber, among others, influenced the risk of non-initiation and single dispensation.

Conclusions: The prevalence of non-initiation and single dispensation of CVD medications and insulin prescribed in PC in is high. Patient and health-system factors, such as place of origin and type of prescriber, should be taken into consideration when prescribing new medications for CVD and diabetes.

Keywords: adherence; cardiovascular diseases; insulin; medication initiation; primary care; real-world data.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angiotensin-Converting Enzyme Inhibitors
  • Cardiovascular Agents* / therapeutic use
  • Cardiovascular Diseases* / drug therapy
  • Cardiovascular Diseases* / prevention & control
  • Cohort Studies
  • Diabetes Mellitus* / drug therapy
  • Female
  • Humans
  • Hypoglycemic Agents* / therapeutic use
  • Insulin* / therapeutic use
  • Male
  • Medication Adherence*
  • Middle Aged
  • Prevalence


  • Angiotensin-Converting Enzyme Inhibitors
  • Cardiovascular Agents
  • Hypoglycemic Agents
  • Insulin