Trouble Getting Started: Predictors of Primary Medication Nonadherence



      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.


      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.


      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).


      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.


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      Linked Article

      • Getting Started: The Benefit of Formulary Decision Support
        The American Journal of MedicineVol. 125Issue 9
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          We 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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