Can Pharmacies Improve First-Time Adherence?

Nearly 30% of first-time prescriptions never make it to the pharmacy, according to a study published in the April issue of the Journal of General Internal Medicine.

Researchers from Harvard University’s Brigham and Women’s Hospital and Massachusetts General Hospital compiled e-prescriptions written by 1,217 prescribers for 75,589 patients over a 12-month period. Claims were used to identify prescriptions that had been filled.

Of 195,930 e-prescriptions, 78% were filled; of 82,245 e-prescriptions for new medications, only 72% were filled. Adherence was higher for prescriptions written by pediatricians, and patients aged 18 and younger were the most likely to fill prescriptions, with a primary adherence rate of 87%.

Primary nonadherence was most common among patients with chronic illnesses, such as hypertension (28.4%), high cholesterol (28.2%), and diabetes (31.4%). According to the study’s authors, previous studies focused on adherence after prescriptions had been filled, but no large studies to date have observed how often and why patients fail to fill prescriptions in the first place.

In a report by the New York Times, the study’s lead author, Michael A. Fischer, MD, is quoted as saying, “We knew before that medication adherence was a concern, but we hadn’t even studied this part of the prescription process.”

The discovery may lead public health initiatives in a new direction, said Dr. Fischer. Interventions that focus on specific medication classes, such as those used to treat common chronic conditions, could dramatically improve overall rates of primary adherence, the study stated.

Such initiatives are already in place in several retail pharmacy chains, which offer special discount programs and counseling services to patients with certain conditions. Publix pharmacies, for example, established a free medication program in March of this year. Patients with a prescription for metformin can visit a Publix pharmacy to receive a free, 30-day supply of the diabetes drug.

If successful, these and other pharmacy-based solutions could provide a model for researchers struggling to design interventions that address the crucial gap between receiving a prescription from a physician and having it filled.

For other articles in this issue, see:

• WHO Reports on Impact of the 2009 H1N1 Flu Season
• Skin Cancer Lessons from MTV's "Jersey Shore"
• NACDS Sets Up Shop in San Diego