Determinants of Primary Nonadherence to Medications Prescribed by General Practitioners Among Adults in Hungary: Cross-Sectional Evaluation of Health Insurance Data

Abstract

Background: Primary nonadherence to prescribed medications occurs when patients do not fill or dispense prescriptions written by healthcare providers. Although it has become an important public health issue in recent years, little is known about its frequency, causes, and consequences. Moreover, the pattern of risk factors shows remarkable variability across countries according to the published results. Our study aimed to assess primary nonadherence to medications prescribed by general practitioners (GPs) and its associated factors among adults in Hungary for the period of 2012–2015. Methods: Data on all general medical practices (GMPs) of the country were obtained from the National Health Insurance Fund and the Central Statistical Office. The ratio of the number of dispensed medications to the number of prescriptions written by a GP for adults was used to determine the medication adherence, which was aggregated for GMPs. The effect of GMP characteristics (list size, GP vacancy, patients’ education provided by a GMP, settlement type [urban or rural], and geographical location [by county] of the center) on adherence, standardized for patients’ age, sex, and eligibility for an exemption certificate, were investigated through generalized linear regression modeling. Results: A total of 281,315,386 prescriptions were dispensed out of 438,614,000 written by a GP. Overall, 64.1% of prescriptions were filled. According to the generalized linear regression coefficients, there was a negative association between standardized adherence and urban settlement type (b = -0.099, 95%CI = -0.103 to -0.094), higher level of education (b = -0.440, 95%CI = -0.468 to -0.413), and vacancy of the general practices (b = -0.193, 95%CI = -0.204 to -0.182). The larger GMP size proved to be a risk factor, and there was a significant geographical inequality for counties as well. Conclusions: More than one-third of the written prescriptions of GPs for adults in Hungary were not dispensed. This high level of nonadherence had great variability across GMPs, and can be explained by structural characteristics of GMPs, the socioeconomic status of patients provided, and the quality of cooperation between patients and GPs. Moreover, our findings suggest that the use of the dispensed-to-prescribed medication ratio in routine monitoring of primary health care could effectively support the necessary interventions.

Is Prescription Nonredemption a Source of Poor Health Among the Roma? Cross-Sectional Analysis of Drug Consumption Data From the National Health Insurance Fund of Hungary

“…The observed 2.8% excess corresponds to 920 redemptions a year in the population of 4,943 Roma people living in the SRC. Higher redemption rates in disadvantaged populations, as indicated by low levels of education and high level of deprivation, was observed previously in Hungarian studies ( Boruzs et al, 2016 ; Boruzs et al, 2018 ; Harsha et al, 2019a ; Harsha et al, 2019b ; Juhász et al, 2020 ) and in other countries as well ( Mauskop and Borden, 2011 ; Jackson et al, 2014 ; Rosicova et al, 2015 ; Ferdinand et al, 2017 ; Pandya and Bajorek, 2017 ; Lee et al, 2018 ; Gast and Mathes, 2019 ).…”

“…Indirect standardization was applied to ensure the comparability of SRC- and CA-specific indicators. Age- and sex-specific expected proportions of redeemed prescriptions were calculated by age- and sex-specific numbers of written prescriptions and the national reference redeemed-to-written ratio for all strata ( Harsha et al, 2019a ; Harsha et al, 2019b ). To control for the confounding effect of the demographic factors, standardized redemption ratios (SRRs) were calculated by dividing accumulated age- and sex-specific numbers of observed redemptions by accumulated age- and sex-specific numbers of expected redemptions of prescribed drugs for both the SRC and the CA.…”

“…It is contracted with each general practitioner (GP) and with each pharmacy, and it centrally registers drug prescriptions and redemptions. Combining the drug consumption database of the NHIFM ( Harsha et al, 2019a ) and the legal opportunity for SRC investigation, an investigation of primary medication adherence among Roma people in SRC in Hungary is feasible without violating Roma rights.…”

Medication Adherence among Patients with Chronic Diseases in Saudi Arabia

“…Adherence to drugs and regimen protocols is essential for therapeutic achievement. Consequently, failure to adhere is a major problem that affects patients and the healthcare system [ 15 ]. Moreover, it leads to the considerable worsening of disease and death, along with high health care costs [ 4 ].…”

Primary Non-adherence to Pharmacotherapy Among Patients With Chronic Diseases: A Case Study of Slovakia

“…On the other hand, non-adherence increases the healthcare costs for chronic diseases. Furthermore, the cost savings due to the lower total costs for pharmacotherapy are then exceeded by additional costs as a consequence of treating the complications (which stem from neglecting the chronic disease treatment) [3], [4].…”