AJM: Medication nonadherence still high; e-prescribing may help
 |
“Medication nonadherence has been identified as a common phenomenon that limits the effectiveness of prescription drug therapy,” Michael A. Fischer, MD, of Brigham and Women's Hospital and Harvard Medical School in Boston, and colleagues wrote. Additionally, patients who do not take medications properly may see poorer outcomes, which also results in high healthcare costs.
Because previous studies have shown medication nonadherence rates to be high, Fischer and colleagues set out to analyze e-prescribing data to evaluate the relationship between patient and prescription factors and nonadherence and to identify predictors of nonadherence.
To do so, Fischer et al analyzed claims for all patients with CVS Caremark drug coverage who received e-prescriptions from the iScribe e-prescribing system during calendar year 2008. The researchers identified 423,616 e-prescriptions for new medications, with 3,634 prescribers and 280,081 patients.
Fischer and colleagues reported the nonadherence rate to be 24 percent; antibiotics accounted for more than 20 percent of e-prescriptions. It was found that patients with higher incomes filled more e-prescriptions more often and that prescriptions that were not covered were rarely filled. Additionally, prescriptions that were sent electronically to the pharmacy were more apt to be filled compared to those printed for patients. Mail-order prescriptions were filled more than 90 percent of the time, the authors reported.
Children and elderly patients were more likely to not fill prescriptions. Additionally, patients living in zip codes with the lowest quintile of per-capita income were 23 percent more likely to not fill prescriptions compared to patients in the highest quintile.
"In terms of the findings, what is important about this is what it adds to our understanding of medication adherence," Fischer, an internal medicine physician and primary investigator of the study, said in an interview. "While we have known that patients often stop taking newly prescribed medications in pretty high percentages, what we didn't know is how to track those patient prescriptions that never get filled."
With e-prescribing methods,prescriptions can be tracked, helping physicians better understand why patients may not fill them. "With these results, we realize that one out of four times that we prescribe a new medication to a patient, that prescription does not get filled," Fischer said.
"This is important to know because it creates an opportunity for us to recognize why so many patients are not taking their medication. Now we are able to talk to the patient about it and find out why these prescriptions are often not filled," he said.
Fischer noted that hospitals and physicians must strategize to find ways to help patients pay for prescriptions and prescribe patients medications that are more affordable.
"Medication adherence is clearly a multifaceted problem, and there are a lot of contributors. This new information helps us identify the extent of the problem to know it's there," Fischer adds. "Now, we can hopefully talk to our patients and pinpoint some of the important predictors that could be modified to help patients with adherence in the future."
One factor that could be modifiable is formulary status. Study results showed that most of the medications e-prescribed were on-formulary or preferred status. The authors reported that nonformulary medications were 31 percent more likely to go unfilled compared to preferred medications.As e-prescribing becomes more prevalent, it will help in two ways: increase convenience because prescriptions are transmitted directly to the pharmacy and give doctors better information about formulary, etc., that may help with adherence, Fischer noted.
"The takehome message here is that better information, better decision support and better communication can help address the medication nonadherence problem," Fischer concluded. “We know the problem is there, now we just have to fix it.”