Nearly a third of patients fail to fill first-time prescriptions, according to a study published April 1 in the Annals of Internal Medicine(www.annals.org). But attention to prescription costs and consistent follow-up with patients -- both factors that family physicians can address with their patients -- should help overcome barriers to adherence identified in the study, say the authors.
For the study, Canadian researchers evaluated the electronic health records of 15,961 patients in a primary care network that included 131 physicians to estimate the incidence of primary nonadherence (failure to fill a first-time prescription) and to ferret out which drug, patient and physician characteristics might be associated with nonadherence. Patients' health records were linked to insurer data on drugs dispensed by community-based pharmacies in relation to specific office visits.
The researchers found that slightly more than 31 percent of all initial drug prescriptions were not filled within nine months. Nonadherence was highest for expensive drugs and preventive therapies for chronic conditions such as ischemic heart disease and depression. In addition, patients with higher copayments, recent hospitalization and more severe comorbid conditions were at increased risk for nonadherence.
Among the researchers' other findings:
- Prescriptions for antibiotics were most likely to be filled.
- Patients who had more visits with the prescribing physician were more likely to fill their prescriptions.
- Older patients were less likely than younger individuals to be nonadherent; the odds of nonadherence dropped by 11 percent for each 10-year increase in age.
- A study published April 1 in the Annals of Internal Medicine found that more than 31 percent of all first-time drug prescriptions were not filled within nine months.
- One solution the study authors offered as a means to improve prescription adherence was for prescribing physicians to enhance their patient follow-up efforts.
- The issue is not new to the AAFP, which partnered in the Prescriptions for a Healthy America coalition last spring to identify ways of improving medication adherence rates in the United States.
Physician gender and years in practice were factored into the analysis because these characteristics have previously been shown to influence prescribing decisions, as does physician-patient communication. However, no significant correlation between these characteristics and nonadherence was seen.
Although the study was conducted in Quebec, where the provincial insurance agency provides health insurance for all provincial residents and drug insurance to about 50 percent of all residents, the lessons it offers are relevant to prescription adherence behavior in the United States.
Boosting Adherence Through Follow-up
One solution the study authors offered as a means to improve adherence was for prescribing physicians to enhance follow-up care -- a concept that is, of course, integral to the patient-centered medical home.
"From my perspective, the thing that stands out is the importance of regular follow-up and continuity of care," AAFP Health of the Public and Science Medical Director Jennifer Frost, M.D., told AAFP News. "This will hopefully improve as more practices become patient-centered medical homes.
"Family doctors should also remain aware of the effect of cost on compliance and, therefore, consider the cost of medication when choosing what to prescribe."
It's also worth noting that with the advent of electronic health records and e-prescribing, family physicians now can more readily access information that indicates whether patients are filling their prescriptions.
Part of the Solution
Medication nonadherence is not a new issue for the AAFP. In May of last year, in fact, the Academy joined a coalition of some 30 organizations dedicated to identifying ways to improve medication adherence rates in the United States. Stakeholders in the Prescriptions for a Healthy America(adhereforhealth.org) initiative include physician, pharmacy, health care industry and consumer groups.
During an event held to mark the coalition's launch, AAFP Director Rebecca Jaffe, M.D., M.P.H., of Wilmington, Del., called poor medication adherence a "leading driver of hospital admissions and readmissions" and the cause of at least 100,000 deaths a year.
According to Jaffe, six out of 10 patients do not take their medications as prescribed by their physicians. This information was based on a coalition-commissioned survey of patients in which respondents were also asked to identify possible ways to improve adherence rates.
Suggestions included increasing one-on-one communication between health care professionals and patients and providing clear information about medications. Survey respondents also suggested following up with patients via emails and by phone with a reminder to take their medications.
Visit the Prescriptions for a Healthy America website for more proposed solutions(adhereforhealth.org) to the dilemma of medication nonadherence, as well as additional resources(adhereforhealth.org) on the topic.