Time to Filling of New Prescriptions for Chronic Disease Medications Among a Cohort of Elderly Patients in the USA

Franklin, Jessica M.; Mahesri, Mufaddal; Krumme, Alexis A.; Barberio, Julie; Fischer, Michael; Brill, Gregory E.; McKay, Caroline; Black, Heather; Choudhry, Niteesh K.

doi:10.1007/s11606-018-4592-6

Cited by 8 publications

(4 citation statements)

References 27 publications

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“…It was possible that the earlier UK advisories might influence prescribing in Canada, but this influence was expected to be weaker than for countries in closer geographic proximity. Although the administrative data in BC captured only drugs dispensed rather than all prescriptions written, whereas the EMR data in the UK included all drugs prescribed, both of these data sources would largely reflect patterns of prescribing behaviour before and after the drug safety advisories [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

Hydroxyzine Initiation Following Drug Safety Advisories on Cardiac Arrhythmias in the UK and Canada: A Longitudinal Cohort Study

et al. 2022

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Introduction Regulatory advisories on hydroxyzine and risk of QT prolongation and Torsade de pointes (TdP) were issued in the UK in April 2015 and Canada in June 2016. We hypothesized patients with risk factors for QT prolongation and TdP, compared with those without risk factors, would be less likely to initiate hydroxyzine in the UK and in British Columbia (BC), Canada, following advisories. Methods We conducted a longitudinal study with repeated measures, and evaluated hydroxyzine initiation in a UK cohort and a concurrent BC control cohort (April 2013–March 2016) as well as in a BC advisory cohort (June 2014–May 2017). Results This study included 247,665 patients in the UK cohort, 297,147 patients in the BC control cohort, and 303,653 patients in the BC advisory cohort. Over a 12-month post-advisory period, hydroxyzine initiation decreased by 21% in the UK (rate ratio 0.79, 95% confidence interval 0.66–0.96) relative to the expected level of initiation based on the pre-advisory trend. Hydroxyzine initiation did not change in the BC control cohort or following the Canadian advisory in the BC advisory cohort. The decrease in hydroxyzine initiation in the UK in the 12 months after the advisories was not significantly different for patients with risk factors compared with those without risk factors. Conclusion Hydroxyzine initiation decreased in the UK, but not in BC, in the 12 months following safety advisories. The decrease in hydroxyzine initiation in the UK was not significantly different for patients with versus without risk factors for QT prolongation and TdP. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-022-01175-2.

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Section: Methodsmentioning

confidence: 99%

Hydroxyzine Initiation Following Drug Safety Advisories on Cardiac Arrhythmias in the UK and Canada: A Longitudinal Cohort Study

et al. 2022

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“…Among patients who faced out-of-pocket medication costs of more than $50 who were not previously taking any medication, more than half failed to fill a new prescription within 30 days. 3…”

Section: Costs and Access To Carementioning

confidence: 99%

“…Among patients who faced out-of-pocket medication costs of more than $50 who were not previously taking any medication, more than half failed to fill a new prescription within 30 days. 3 In states that accepted the Affordable Care Act (ACA) Medicaid expansion, many more patients starting dialysis were enrolled in Medicaid, fewer were uninsured, more had an arteriovenous (AV) fistula rather than a venous catheter for dialysis access (an AV fistula is the preferred access method, but the fistula graft takes time to mature, requiring planning months before the start of dialysis), and the 1-year mortality rate for new dialysis patients fell faster (to 6.1% from 6.9%) than in non-expansion states (to 6.8% from 7.0%). Mortality reductions were largest for black patients and those aged 19 to 44 years.…”

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confidence: 99%

Health Care Crisis by the Numbers

2019

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We summarize recent data on health and health care in the United States. Many millions suffer financial distress due to medical bills and forego needed care because of costs. Pay-for-performance programs have failed to achieve the results promised and in some cases have backfired. Health care firms expend huge amounts on marketing that provides no benefit to patients. Millions of health care workers, particularly women of color, are so poorly paid that they live in poverty, and gender-based pay inequities remain common in the health sector. Polls continue to show strong popular support for a single-payer reform, but politicians continue to resist it.

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“…1 It is difficult to study, given that direct observation of medication consumption is generally not feasible. However, Franklin et al 2 expand our limited understanding of prescription-filling behavior through conducting a cohort study using linked US-based healthcare databases that contain both prescribing data from physician records and dispensation data.…”

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confidence: 99%

Capsule Commentary on Franklin et al., Time to Filling of New Prescriptions for Chronic Disease Medications Among a Cohort of Elderly Patients in the USA

Gamble

2018

J GEN INTERN MED

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W hen a patient forgoes filling a new prescription, this is known as primary medication non-adherence. Medication non-adherence is costly to the healthcare system, associated with increased hospitalization and worse patient health outcomes. 1 It is difficult to study, given that direct observation of medication consumption is generally not feasible. However, Franklin et al. 2 expand our limited understanding of prescription-filling behavior through conducting a cohort study using linked US-based healthcare databases that contain both prescribing data from physician records and dispensation data.Franklin et al. found that about 20% of new prescriptions for adults over 65 years of age went unfilled within 30 days (25% within 7 days and 9% within 1 year) of receiving a prescription to manage common chronic diseases (diabetes, hypertension, dyslipidemia, asthma/COPD, and osteoporosis) with no significant differences between therapeutic classes. This magnitude of primary non-adherence is marginally lower compared to that of prior studies. Others have also found substantial variation across therapeutic classes. 3,4 Researchers should continue to study variation across therapeutic areas and variation within a patient's treatment course.Using several clever analytic approaches, Franklin et al. give us two key variables for identifying patients at risk of not filling their new prescription: number of current medications and out-of-pocket costs. Although they assessed a suite of covariates as predictors for primary non-adherence and had higher predictive accuracy than previous studies, factors affecting prescription-filling behavior such as fear of adverse effects, uncertainty of benefit, and the patient's rationale for choosing not to fill their prescription were not measured. Other important chronic diseases were not considered such as depression, heart failure, rheumatoid arthritis, and chronic kidney disease, limiting the generalizability of their findings. Others have recently found that the mode of prescription (electronic vs. paper) impacts the prevalence of primary nonadherence. 5 What are the take-home points for health care practitioners? First, one out of five new prescriptions for common chronic conditions may go unfilled. Second, when prescribing a new medication for hypertension, diabetes, osteoporosis, or dyslipidemia to a patient who is not taking any other medications and required a co-pay of over $5, additional follow-up is prudent.

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Time to Filling of New Prescriptions for Chronic Disease Medications Among a Cohort of Elderly Patients in the USA

Abstract: 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.

Cited by 8 publications

References 27 publications

Hydroxyzine Initiation Following Drug Safety Advisories on Cardiac Arrhythmias in the UK and Canada: A Longitudinal Cohort Study

Hydroxyzine Initiation Following Drug Safety Advisories on Cardiac Arrhythmias in the UK and Canada: A Longitudinal Cohort Study

Health Care Crisis by the Numbers

Capsule Commentary on Franklin et al., Time to Filling of New Prescriptions for Chronic Disease Medications Among a Cohort of Elderly Patients in the USA

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