@article{7742,
  author = {Michael A. Fischer and Margaret R. Stedman and Joyce Lii and Christine Vogeli and William H. Shrank and Alan Brookhart and Joel S. Weissman},
  title = {Primary medication non-adherence: analysis of 195,930 electronic prescriptions.},
  abstract = {<p><b>BACKGROUND: </b>Non-adherence to essential medications represents an important public health problem. Little is known about the frequency with which patients fail to fill prescriptions when new medications are started ("primary non-adherence") or predictors of failure to fill.</p><p><b>OBJECTIVE: </b>Evaluate primary non-adherence in community-based practices and identify predictors of non-adherence.</p><p><b>PARTICIPANTS: </b>75,589 patients treated by 1,217 prescribers in the first year of a community-based e-prescribing initiative.</p><p><b>DESIGN: </b>We compiled all e-prescriptions written over a 12-month period and used filled claims to identify filled prescriptions. We calculated primary adherence and non-adherence rates for all e-prescriptions and for new medication starts and compared the rates across patient and medication characteristics. Using multivariable regressions analyses, we examined which characteristics were associated with non-adherence.</p><p><b>MAIN MEASURES: </b>Primary medication non-adherence.</p><p><b>KEY RESULTS: </b>Of 195,930 e-prescriptions, 151,837 (78%) were filled. Of 82,245 e-prescriptions for new medications, 58,984 (72%) were filled. Primary adherence rates were higher for prescriptions written by primary care specialists, especially pediatricians (84%). Patients aged 18 and younger filled prescriptions at the highest rate (87%). In multivariate analyses, medication class was the strongest predictor of adherence, and non-adherence was common for newly prescribed medications treating chronic conditions such as hypertension (28.4%), hyperlipidemia (28.2%), and diabetes (31.4%).</p><p><b>CONCLUSIONS: </b>Many e-prescriptions were not filled. Previous studies of medication non-adherence failed to capture these prescriptions. Efforts to increase primary adherence could dramatically improve the effectiveness of medication therapy. Interventions that target specific medication classes may be most effective.</p>},
  year = {2010},
  journal = {J Gen Intern Med},
  volume = {25},
  pages = {284-90},
  month = {04/2010},
  issn = {1525-1497},
  doi = {10.1007/s11606-010-1253-9},
  language = {eng},
}