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Using Continuous Data Tracking Technology to Study Exercise Adherence in Pulmonary Rehabilitation

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Trouble getting started: predictors of primary medication nonadherence.

Michael A Fischer¹, Niteesh K Choudhry, Gregory Brill

¹Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. mfischer@partners.org

The American Journal of Medicine

|October 25, 2011

Summary

This summary is machine-generated.

Electronic prescribing data revealed that 24% of new medication prescriptions were not filled, highlighting significant patient nonadherence. Interventions addressing cost and electronic health integration are key to improving medication adherence.

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Area of Science:

Health Informatics
Pharmacoepidemiology
Health Services Research

Background:

Patient nonadherence to prescribed medications is a widespread issue impacting treatment efficacy.
Traditional adherence studies often overlook nonadherence occurring before the first prescription fill.
Electronic prescribing (e-prescribing) systems offer novel opportunities to track initial prescriptions and identify previously undetected nonadherence.

Purpose of the Study:

To analyze electronic prescribing data to determine the rate of primary nonadherence to newly prescribed medications.
To identify patient, prescriber, and prescription characteristics associated with primary nonadherence.
To explore the impact of e-prescribing transmission methods on medication adherence.

Main Methods:

Analysis of e-prescribing and filled claims data for patients with CVS Caremark drug coverage in 2008.
Matching e-prescriptions with filled claims using drug name, e-prescription date, and filled claim date (up to 180 days).
Development of multivariable models to identify predictors of primary nonadherence to newly prescribed medications.

Main Results:

A primary nonadherence rate of 24.0% was observed across 423,616 e-prescriptions.
Nonadherence was associated with nonformulary medication status (OR 1.31) and low-income ZIP code residence (OR 1.23).
Direct electronic transmission of e-prescriptions to pharmacies significantly reduced nonadherence (OR 0.54) compared to printing for patients.

Conclusions:

A substantial proportion (24%) of new electronic prescriptions are not filled by patients.
Economic factors and the level of electronic integration within healthcare systems are critical areas for intervention.
Targeted strategies addressing cost barriers and enhancing digital health integration show promise for improving medication adherence.