University of Tartu, Department of Traumatology and Orthopedics, L.Puusepa 8, Tartu, Estonia; Estonian State Agency of Medicines, Nooruse 1, Tartu, Estonia.
University of Tartu, Institute of Family Medicine and Public Health, Department of Epidemiology and Biostatistics, Ravila 19, Tartu, Estonia.
Res Social Adm Pharm. 2018 Aug;14(8):776-783. doi: 10.1016/j.sapharm.2017.10.003. Epub 2017 Oct 5.
Medication adherence can be divided into primary and secondary adherence. Primary medication non-adherence (PMN) occurs when a patient does not obtain medicine with their initial prescription. Secondary non-adherence measures prescription refills among patients who previously filled their first prescription. While secondary non-adherence has been studied thoroughly, PMN has been assessed less extensively, due to lack of available data. Estonian ePrescription system might prove a valuable tool for this.
The aim of this study was to evaluate PMN and the interval between prescribing and dispensing of medicines using the Estonian ePrescriptions database to establish its potential use for this purpose and for other qualitative drug utilization research measures. Osteoporosis medicines were used as an example.
The Estonian Prescription Centre was used to evaluate if patients purchase medicines after initial prescription of osteoporosis medicine. Prescriptions from 2012 to 2015 of all patients over 18 were included. PMN was defined as the first prescription not being dispensed before it expired (60 days). The rate of PMN was calculated.
Estonian ePrescription System enabled fast evaluation of PMN of osteoporosis patients based on data about prescribing, dispensing and time intervals in-between. Of patients who started osteoporosis treatment 13.1% were primary non-adherent. Of primary non-adherent patients 42% still started treatment at some point during the study. Of patients who did purchase their first prescription 80.4% did so within a week and 95% within 25 days.
The Estonian ePrescription system is a useful tool for monitoring PMN. The PMN of osteoporosis medicines was identified as lower than previously reported. More similar type of studies about other groups of medicines would be needed to understand the pattern of PMN and give valuable information to healthcare specialists about how to increase initiation of treatment.
药物依从性可分为主要依从性和次要依从性。当患者未按初始处方获得药物时，即发生主要药物不依从（PMN）。次要不依从性则衡量首次处方后已完成处方 refill 的患者的依从性。虽然已经对次要不依从性进行了深入研究，但由于缺乏可用数据，PMN 的评估相对较少。爱沙尼亚电子处方系统可能为此提供了有价值的工具。
本研究旨在使用爱沙尼亚电子处方数据库评估 PMN 和开出处方与配药之间的时间间隔，以确定其在这方面和其他定性药物利用研究措施中的潜在用途。以骨质疏松症药物为例。
使用爱沙尼亚处方中心评估患者在初始骨质疏松症药物处方后是否购买药物。纳入了 2012 年至 2015 年所有 18 岁以上患者的处方。PMN 定义为在处方过期（60 天）之前未配药的首次处方。计算 PMN 的发生率。
爱沙尼亚电子处方系统能够快速评估基于开处方、配药和中间时间间隔的骨质疏松症患者的 PMN。开始骨质疏松症治疗的患者中，有 13.1%为主要不依从者。在主要不依从者中，42%仍在研究期间的某个时候开始治疗。购买第一份处方的患者中，80.4%在一周内购买，95%在 25 天内购买。
爱沙尼亚电子处方系统是监测 PMN 的有用工具。骨质疏松症药物的 PMN 被确定低于先前报告的水平。需要更多类似类型的关于其他药物组的研究，以了解 PMN 的模式，并为医疗保健专业人员提供有关如何增加治疗启动的有价值信息。
