Department of Family Medicine, Medical University of Lodz, Łódź, Poland.
Ministry of Health, Warsaw, Poland
Pol Arch Intern Med. 2020 Jan 31;130(1):8-16. doi: 10.20452/pamw.14994. Epub 2019 Sep 27.
Primary nonadherence to medication occurs when a patient does not fill a prescription and often leads to suboptimal patient outcomes, lost productivity, and increased net costs. Pilot introduction of electronic prescriptions (e‑prescriptions) in Poland took place in 2018, enabling nationwide assessment of primary nonadherence.
To determine the prevalence and drivers of primary nonadherence in Poland.
This retrospective analysis included data from all e‑prescriptions issued in Poland in 2018. Primary nonadherence was defined as not filling a prescription within 1 month from the date of issuing.
Out of all 119 880 e‑prescriptions issued in Poland in 2018, 94 913 were filled, thus the primary nonadherence rate reached 20.8%. Although no differences in primary nonadherence were observed between sexes, age was found to have a significant effect, with older groups showing lower rates of primary nonadherence. In addition, slightly lower rates of primary nonadherence (17.0%) were found for e‑prescriptions issued for selected drugs of key importance (n = 47 492). Multivariable analysis performed within this subset showed that those aged ≥75 years had the lowest odds for nonadherence (odds ratio, 0.55; 95% CI, 0.48-0.64). Differences in primary nonadherence rates were observed across therapeutic areas (lowest value in antibiotics, 14.3%), drug classes (lowest value in sulfonylureas, 13.2%), and individual drugs. Primary nonadherence rates were lower for drugs covered by the "Leki 75+" program, which makes them free of charge for those aged 75 years or older.
A high percentage of prescriptions issued in Poland are never filled. E‑prescriptions allow the identification and analysis of drivers of this phenomenon. Our findings may help designing national health and medicine policies.
患者未配药即出现首要药物不依从，通常会导致患者结局欠佳、生产力损失和净成本增加。2018 年，波兰开始试行电子处方（e-prescriptions），从而实现全国范围内对首要药物不依从的评估。
确定波兰首要药物不依从的流行程度和驱动因素。
本回顾性分析纳入了 2018 年波兰所有开具的 e-prescriptions 数据。首要药物不依从被定义为自处方开具之日起 1 个月内未配药。
2018 年，波兰共开具 119880 张 e-prescriptions，其中 94913 张得到配药，因此首要药物不依从率达到 20.8%。尽管男女之间未观察到首要药物不依从的差异，但年龄具有显著影响，年龄较大的组首要药物不依从率较低。此外，对于选定的关键重要药物（n=47492）开具的 e-prescriptions，首要药物不依从率略低（17.0%）。在该亚组内进行的多变量分析显示，年龄≥75 岁者不依从的可能性最低（比值比，0.55；95%CI，0.48-0.64）。不同治疗领域（抗生素最低，14.3%）、药物类别（磺酰脲类最低，13.2%）和个别药物的首要药物不依从率存在差异。“Leki 75+”计划涵盖的药物的首要药物不依从率较低，该计划使 75 岁及以上的人群免费获得这些药物。
波兰开具的大量处方从未配药。电子处方允许识别和分析这一现象的驱动因素。我们的研究结果可能有助于制定国家卫生和医学政策。
