E-prescribing and primary noncompliance: physician and patient experience

The success of medication therapy, regardless of how it is prescribed, hinges on patient adherence starting with primary compliance (filling prescriptions.) This study examined primary noncompliance (PNC) in the context of e-prescribing (e-Rx).

An e-Rx-promotion project was supplemented by mailed alerts to clinicians in private practice regarding PNC to improve adherence to therapy. We included physicians who were willing to participate and plan members who received prescriptions from these providers. Physicians and patients were surveyed about their experience with e-Rx and PNC.

The rate of PNC was 15%. Provider survey respondents indicated satisfaction with e-Rx (83%.) Most of them were satisfied with improved office efficiency (74%) and certain e-Rx features. Patient survey results indicated that the top 2 reasons for PNC were perception of lack of efficacy and concern about side effects. High cost and absence of symptoms ranked next. Only 34% of patients felt that e-Rx improves medication safety significantly, and many of them were not aware of e-Rx use by their physicians. Most patients and physicians reported being comfortable discussing PNC.

PNC is a significant cause of poor adherence to drug therapy, and nonfinancial patient concerns are the primary reason. Mailed PNC alerts to providers are resource intensive and may be supplanted by certain e-Rx standards. Clinicians who adopted e-Rx report a largely positive experience with e-Rx. Recent changes in Medicare rules will impact the use of this technology but challenges remain and require continued support to hasten the adoption of e-Rx. Case management programs may improve primary compliance by incorporating exchange of e-Rx data.