Division of Pharmacoepidemiology & Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Merck & Co., Inc., Kenilworth, NJ, USA.
J Gen Intern Med. 2018 Nov;33(11):1877-1884. doi: 10.1007/s11606-018-4592-6. Epub 2018 Jul 27.
Data on primary nonadherence remains sparse, due to a lack of data resources that combine information on medication prescribing and dispensing. In addition, previous work on primary nonadherence has used follow-up periods ranging from 30 days up to 18 months, making results difficult to compare.
To evaluate the prevalence and predictors of primary nonadherence by measuring time until filling in a cohort of elderly patients.
Retrospective cohort study of new prescription episodes.
Data comes from a linked database of electronic health records and claims for patients aged ≥ 65 years enrolled in Medicare Parts A, B, and D during 2007-2014. We identified patients receiving a new prescription for a chronic disease medication with continuous Medicare enrollment for 180 days prior to the index prescription order and no fills or orders for the medication during this period.
Time until filling of the index prescription for up to 1 year.
In 32,586 new medication orders, the majority (75%; 95% confidence interval [CI] 74-75%) of new prescriptions were filled within 7 days, 81% (81-82%) were filled within 30 days, and 91% (91-92%) were filled within 1 year. The rate and timing of dispensing were similar across therapeutic areas. Timing of initial filling within 7 days or within 30 days could be predicted with moderate accuracy (C-statistics = 0.70-0.74). Patients with > 5 current medications on hand at the time of the index prescription and average out-of-pocket medication costs < $5 filled 89% of prescriptions within 7 days. Patients with no current medications and out-of-pocket costs > $50 filled only 25% of prescriptions within 7 days.
Nearly 20% of patients do not fill a new chronic disease prescription within 30 days. Patients with fewer recent fills and higher out-of-pocket costs are at higher risk of primary nonadherence.
由于缺乏将药物处方和配药信息结合起来的数据资源，主要的不依从数据仍然很少。此外，之前关于主要不依从性的研究使用了从 30 天到 18 个月不等的随访期，使得结果难以比较。
通过测量填充时间，评估老年患者队列中主要不依从的发生率和预测因素。
新处方发作的回顾性队列研究。
数据来自 2007-2014 年期间参加医疗保险 A、B 和 D 部分的年龄≥65 岁的患者的电子健康记录和索赔的链接数据库。我们确定了在索引处方医嘱前 180 天内接受慢性疾病药物新处方且在此期间无药物配给或医嘱的患者。
索引处方的填充时间最长可达 1 年。
在 32586 个新的药物订单中，大多数（75%；95%置信区间[CI]74-75%）新处方在 7 天内完成，81%（81-82%）在 30 天内完成，91%（91-92%）在 1 年内完成。在不同治疗领域，配药的速度和时间相似。在 7 天内或 30 天内首次配药的时间可以较准确地预测（C 统计量=0.70-0.74）。在索引处方时手头有超过 5 种当前药物的患者和平均自付药物费用<50 美元的患者，89%的处方在 7 天内完成。没有当前药物且自付费用超过 50 美元的患者，7 天内仅完成 25%的处方。
近 20%的患者在 30 天内未填写新的慢性疾病处方。最近配药次数较少且自付费用较高的患者，主要不依从的风险较高。
