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April 9, 2014
What Prescriptions Are Patients Least Likely to Fill?
Quebec—A new study, which found that nearly a third of patients fail to fill first-time prescriptions within 9 months, also determined that hormones and synthetics, particularly thyroid medications, have the lowest adherence rates among pharmaceutical classes. The study, conducted by researchers from the Canadian Institutes of Health Research, was published recently in the Annals of Internal Medicine. Results indicate that 36.3% of patients failed to fill first-time prescriptions for hormones and synthetics; the nonadherence rate for thyroid agents was 49.4%. Other prescriptions with low fill rates were ear, nose, and throat preparations (34.2%) and cardiovascular drugs (34.7%). On the other hand, only 24.2% of patients didn’t pick up anti-infectives (24.2%). Among the 20 most frequently prescribed drugs, nonadherence was highest in initial treatment with L-thyroxine (49.4%), fluticasone (40.5%), and atorvastatin (36.8%). “Although primary nonadherence rates for chronic preventive therapies is consistent with the only other two large-scale studies conducted in primary care, this was the first study, to our knowledge, to characterize the rates of primary nonadherence by actual treatment indication,” the authors note. “This is relevant because primary nonadherence rates by pharmacologic class likely reflects differences in the reasons for treatment, expected length of therapy, and extent to which symptoms will be relieved by treatment.” For the study, researchers focused on 15,961 patients in a primary care network for 131 physicians. To determine medication adherence, they linked incident prescriptions from primary care electronic health records between 2006 and 2009 to insurance data on all drugs dispensed from community-based pharmacies. In general, nonadherence was found to be highest for expensive drugs and chronic preventive therapies for conditions such as ischemic heart disease and depression. The risk of failing to ever fill prescriptions was greatest for patients with higher copayments, recent hospitalization, and more severe comorbid conditions, according to the study. Patients who had a higher number of visits with the prescribing physician were more likely to fill their prescriptions, however, and the authors suggest that more follow-up care—as well as lower copayments—might reduce the risk for nonadherence. Increasing patient age also raised the odds of nonadherence, the report said. The authors call for future research to “estimate the contribution of medication attitudes and belief to the likelihood of primary nonadherence as well as the effect of nonadherence on subsequent illness, death and healthcare use.”
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