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Prescription adherence with CVD medications complex process in US
Choudhry N. Arch Intern Med. 2011;171:814-822.
Salanitro A. Arch Intern Med. 2011;171:822-823.
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A new study appearing in the Archives of Internal Medicine has highlighted the complexity involved with prescription adherence with CVD medications in the United States, leading researchers to conclude that it may be necessary to reduce this complexity to improve adherence.
“Because nonadherence is associated with excess morbidity and mortality, our findings suggest that therapeutic complexity may undermine the goals of chronic disease management,” they wrote. “In addition, these results highlight an essential aspect of the therapeutic cascade that may be particularly burdensome and which few clinicians likely consider when making prescribing decisions.”
Researchers used prescription claims data from CVS Caremark, a pharmacy benefit manager in Rhode Island with more than 50 million beneficiaries in the United States, to generate these results. The study population consisted of individuals who were prescribed a statin (n=1,827,395) or an ACE inhibitor or renin angiotensin receptor blocker (n=1,480,304) from June 1, 2006, to May 30, 2007. Complexity was determined by measuring the number of medications, pharmacies, pharmacy visits, prescribers and refill consolidation for 3 months after first prescription.
Overall, 80% of medication users in both cohorts were prevalent users, meaning they had received a prescription for a member of the therapeutic class within the prior 12 months. During a 1-year period, researchers found that statin users (mean age, 63 years; 51% female) filled 11.4 prescriptions for 6.3 different medications, had prescriptions written by two prescribers and made five visits to the pharmacy. Data for angiotensin receptor blocker and ACE inhibitor users was similar.
According to adjusted models, patients who had the least refill consolidation, which was determined by measuring the number of visits per fill, had 8% lower adherence rates in the year than patients with the greatest refill consolidation.
For Amanda H. Salanitro, MD, and Sunil Kripalani, MD, with the department of medicine, Vanderbilt University, Nashville, Tenn., and authors of the accompanying editorial, even with the study’s limitations, they wrote that it provides a valuable step forward in measuring the complexities of prescription medication management, as well as its effect on adherence.
“Based on the results of this study, additional research is needed to determine if a reduction in therapeutic complexity (ie, fewer prescribers and/or pharmacies or maximal refill consolidation) positively affects adherence,” they said. “Few published adherence interventions have addressed complexity comprehensively. Such programs are most likely to benefit patients with multi-morbidity and complex medication regimens.”
Disclosures: Dr. Kripalani is a consultant to and holds equity in PictureRx, LLC, and has served as a consultant to Pfizer and Bristol-Myers Squibb/Sanofi-Aventis. Dr. Salanitro reports no relevant financial disclosures.
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