Abstract
Background
Patient nonadherence to prescribed medication is common and limits the effectiveness
of treatment for many conditions. Most adherence studies evaluate behavior only among
patients who have filled a first prescription. The advent of electronic prescribing
(e-prescribing) systems provides the opportunity to track initial prescriptions and
identify nonadherence that may have previously been undetected.
Methods
We analyzed e-prescribing data and filled claims for all patients with CVS Caremark
(Woonsocket, RI) drug coverage who received e-prescriptions from the iScribe e-prescribing
system in calendar 2008. We matched e-prescriptions with filled claims by using data
on the drug name, date of e-prescription, and date of filled claims, allowing up to
180 days for patients to fill e-prescriptions. We evaluated the rate of primary nonadherence
to newly prescribed medications across multiple characteristics of patients, prescribers,
and prescriptions and developed multivariable models to identify predictors of nonadherence.
Results
We identified 423,616 e-prescriptions for new medications, with 3634 prescribers and
280,081 patients. The primary nonadherence rate was 24.0%. Several factors were associated
with nonadherence to e-prescriptions, including nonformulary status of medications
(odds ratio [OR] 1.31 compared with preferred medications; 95% confidence interval
[CI], 1.26-1.36; P<.001) and residence in a low-income ZIP code (OR 1.23 compared with high-income ZIP
code; 95% CI, 1.17-1.30; P<.001) Nonadherence occurred less often when e-prescriptions were transmitted directly
to the pharmacy rather than printed to give to patients (OR 0.54; 95% CI, 0.52-0.57;
P<.001).
Conclusion
24% of e-prescriptions for new medications were not filled. Our results suggest that
interventions to address economic barriers and increase electronic integration in
the healthcare system may be promising approaches to improve medication adherence.
Keywords
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Article Info
Footnotes
Funding: This work is supported by a research grant from CVS Caremark . Dr Shrank is supported by a career development award from the National Heart, Lung and Blood Institute ( HL-090505 ).
Conflict of Interest: Dr Brennan, Dr Liberman, and Mr Hutchins are employees of CVS Caremark. Dr Schneeweiss has consultancies with WHISCON, RTI Health Solutions, and The Lewin Group. The remaining authors have no conflicts of interest to report.
Authorship: All authors had access to the data and played a role in writing this manuscript.
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Getting Started: The Benefit of Formulary Decision SupportThe American Journal of MedicineVol. 125Issue 9
- PreviewWe read with great interest the study entitled, “Trouble Getting Started: Predictors of Primary Medication Nonadherence.”1 Fischer et al conclude that physicians' attention to formulary status and cost of medication may considerably affect adherence and recommend future study in this regard.1 We concur that patients' cost must be minimized to optimize treatment adherence and outcomes. Our own research showed that patients who were electronically prescribed cholesterol-lowering medication via an electronic health record with built-in formulary decision support were 59% more likely than those who received a handwritten prescription to reach a favorable clinical end point: achieving their low-density lipoprotein goal.
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