Centre for Health Services and Policy Research, School of Population and Public Health (Zeitouny, Cheng, Wong, McGrail, Law), University of British Columbia, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital, Toronto, Ont.
CMAJ. 2023 Aug 8;195(30):E1000-E1009. doi: 10.1503/cmaj.221018.
Most research on medication adherence has focused on secondary nonadherence and persistence to therapy. Medication prescriptions that are never filled by patients (primary nonadherence) remain understudied in the general population.
We linked prescribing data from primary care electronic medical records to comprehensive pharmacy dispensing claims between January 2013 and April 2019 in British Columbia (BC) to estimate primary nonadherence, defined as failure to dispense a new medication or its equivalent within 6 months of the prescription date. We used hierarchical multivariable logistic regression to determine prescriber, patient and medication factors associated with primary nonadherence among community-dwelling patients in primary care.
Among 150 565 new prescriptions to 34 243 patients, 17% of prescriptions were never filled. Primary nonadherence was highest for drugs prescribed mostly on an as-needed basis, including topical corticosteroids (35.1%) and antihistamines (23.4%). In multivariable analysis, primary nonadherence was lower for prescriptions issued by male prescribers (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.50-0.88). Primary nonadherence decreased with patient age (OR 0.91, 95% CI 0.90-0.92 for each additional 10 years) but increased with polypharmacy among patients aged 65 years or older. Patients filled more than 82% of their medication prescriptions within 2 weeks after their primary care provider visit.
The prevalence of primary nonadherence to new prescriptions was 17%. Interventions to address primary nonadherence could target older patients with multiple medication use and within the first 2 weeks of the prescription issue date.
大多数关于药物依从性的研究都集中在治疗的次要不依从和持续上。患者从未配过药的药物处方（主要不依从）在普通人群中仍研究不足。
我们将初级保健电子病历中的处方数据与 2013 年 1 月至 2019 年 4 月期间不列颠哥伦比亚省（BC）的综合药房配药记录相链接，以估计主要不依从性，定义为在处方日期后 6 个月内未配药或未配等量药物。我们使用分层多变量逻辑回归来确定初级保健中社区居住患者的医生、患者和药物相关因素与主要不依从性之间的关系。
在 150565 名新处方给 34243 名患者中，有 17%的处方从未配药。按需开具的药物（包括局部皮质类固醇和抗组胺药）的主要不依从率最高（35.1%和 23.4%）。在多变量分析中，男性医生开具的处方的主要不依从率较低（比值比 [OR] 0.66，95%置信区间 [CI] 0.50-0.88）。主要不依从性随患者年龄的增加而降低（每增加 10 岁，OR 0.91，95%CI 0.90-0.92），但在 65 岁及以上的患者中，随着药物种类的增加而增加。患者在接受初级保健提供者就诊后的 2 周内，配药的比例超过 82%。
新处方的主要不依从率为 17%。针对主要不依从性的干预措施可能针对使用多种药物的老年患者，并在处方开具后的前 2 周内进行。
