AJM onlineClinical research studyTrouble Getting Started: Predictors of Primary Medication Nonadherence
Section snippets
Data Sources
Data were obtained from 2 main sources: (1) iScribe, an e-prescribing system used in outpatient settings, and (2) a large pharmacy benefit management company. Both iScribe and the pharmacy benefit management company are owned and operated by CVS Caremark (Woonsocket, RI). During the study period, iScribe e-prescriptions were received by patients in all 50 states; the 8 states with the highest volume of iScribe use were New Jersey, New York, Tennessee, Florida, Texas, Maryland, South Carolina,
Results
A total of 3634 prescribers used the iScribe system during the 2008 calendar year. There were 280,081 patients who received iScribe e-prescriptions and filled at least 1 prescription claim. An additional 29,419 patients did not have any filled medication claims during the 2 years spanned by the claims data and thus were included only in secondary analyses.
A total of 1,147,701 e-prescriptions were written in 2008. Of these, 106,838 (9.3%) duplicates were excluded (7.2% reissued same day; 2.1%
Discussion
Medication nonadherence is common, but only with the recent advent of e-prescribing has the true extent of nonadherence become apparent. Our study adds to recent analyses documenting considerable nonadherence to e-prescribed medication.12, 13, 14, 15, 16 This larger and more nationally representative study confirms the high rates of nonadherence seen in other settings, finding that 24% of new e-prescriptions are not filled within 6 months. Most important, our present study identifies
Conclusions
This study adds to other recent analyses that demonstrate how common nonadherence is, but goes further by identifying factors that may be amenable to interventions to improve medication adherence. First, attention to formulary status and medication costs may promote adherence, although this will need to be tested further. Second, interventions aimed at addressing economic barriers to medication filling may help in addressing the income-based disparities in adherence that we observed. Finally,
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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.