Impact of initial medication non-adherence on use of healthcare services and sick leave: a longitudinal study in a large primary care cohort in Spain

Aznar-Lou, Ignacio; Fernández, Ana; Gil-Girbau, Montserrat; Sabés-Figuera, Ramón; Fajó-Pascual, Marta; Peñarrubia-María, Maria Teresa; Serrano‐Blanco, Antoni; Moreno-Peral, Patrícia; Sánchez-Niubò, Albert; March-Pujol, Marian; Rubio-Valera, María

doi:10.3399/bjgp17x692129

Cited by 23 publications

(12 citation statements)

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“…Moreover, even from a short -term perspective, initial medication nonadherence has a negative impact on productivity due to lower work ability and leads to increased net costs. 11 The Polish healthcare system, like many other European systems, is a health insurance system based on a principle of social solidarity. Health services are provided free of charge to those insured (ie, practically the entire population) by both public and private healthcare providers, and are paid by the only national health payer-the Polish National Health Fund (Narodowy Fundusz Zdrowia).…”

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confidence: 99%

Primary non-adherence to medication and its drivers of in Poland: findings of the analysis of the e-prescription pilot

Kardas

Cieszyński

Czech³

et al. 2019

Polish Archives of Internal Medicine

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IntroductIon 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. objEctIvEs To determine the prevalence and drivers of primary nonadherence in Poland. MEthods 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. rEsuLts 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. concLusIons 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.

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confidence: 99%

Primary non-adherence to medication and its drivers of in Poland: findings of the analysis of the e-prescription pilot

Kardas

Cieszyński

Czech³

et al. 2019

Polish Archives of Internal Medicine

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“…The number is assumed to be higher in developing countries, given limited access to healthcare services and paucity of medical providers and finances. Medication nonadherence has been frequently reported to be associated with adverse clinical outcomes [ 2 ], decreased quality of life [ 3 ], as well as higher utilisation of healthcare resources [ 4 ].…”

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confidence: 99%

A community-based nurse-led medication self-management intervention in the improvement of medication adherence in older patients with multimorbidity: protocol for a randomised controlled trial

et al. 2021

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Background Older patients suffering from multimorbidity are at high risk of medication nonadherence. It has been well established that self-management support is an effective strategy to enhance medication adherence for patients with chronic conditions. However, little is known about the effect of the medication self-management intervention in older patients with multimorbidity. This paper presents the protocol for a study that aims to evaluate the effectiveness of a nurse-led medication self-management intervention in improving medication adherence and health outcomes for community-dwelling older patients with multimorbidity. Methods The study protocol follows the recommendations of the Standard Protocol Items: Recommendations for Interventional Trials 2013 statement. This study is a multicentre, single-blind, two-arm randomised controlled trial. Older patients with multimorbidity will be recruited from three community health centres in Changsha, China. A total of 136 participants will be randomly allocated to receive usual care or usual care plus the medication self-management intervention. The intervention will be delivered by community nurses. The 6-week intervention includes three face-to-face education sessions and two weekly follow-up phone calls. Participants in the control group continue to receive all respects of usual care offered by community healthcare providers, including chronic disease management, drug prescription, referral to hospital specialists, health education and consultations regarding patients’ diseases and treatments during centre visits. The primary outcome is medication adherence as measured by the 5-item Medication Adherence Report Scale. Secondary outcomes include medication self-management capacity (medication knowledge, medication beliefs, medication social support, medication skills, and medication self-efficacy), treatment experiences (medication treatment satisfaction and treatment burden), quality of life, and utilisation of healthcare services. All outcomes will be measured at baseline, immediately post-intervention, and at 3-month post-intervention. Discussion This study will provide evidence about the effectiveness of a medication self-management intervention, delivered by nurses, for older patients with multimorbidity and adherence problems. It is expected that the results of the study, if proven effective in improving patients’ adherence and health outcomes, will provide evidence-based self-management support strategies for healthcare providers in routine chronic disease management in community settings. Trial registration The trial is registered at ChiCTR.org.cn (ChiCTR2000030011; date February 19, 2020).

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“…Nonadherence worsens health outcomes and increases the risk of mortality and hospitalization (Xu et al, 2017;Kim et al, 2018). Greater use of medical services and productivity losses are also consequences of medication nonadherence, which places a significant cost burden on healthcare systems (Aznar-Lou et al, 2017;Cutler et al, 2018). Nonadherence is higher when more expensive medicines are prescribed and when copayment is applied (Kazerooni et al, 2013;González López-Valcárcel et al, 2017;Aznar-Lou et al, 2018); interventions that reduce the copayment contributions or exempt the patient from payment have effectively proven to reduce nonadherence (Chernew et al, 2008;Maciejewski et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Who Suffers From Pharmaceutical Poverty and What Are Their Needs? Evidence From a Spanish Region

et al. 2021

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Background: Pharmaceutical poverty occurs when a patient cannot afford the cost of prescribed medication and/or medical products. Nonprofit organizations are covering the cost of medication to those patients in some contexts. The aim of the study was to describe the population of beneficiaries of the PB, a nongovernmental organization based on the primary healthcare system, which provides free-of-charge access to medicines and their utilization pattern of medicines and healthcare products.Methods: This was an observational study using PB beneficiary data collected between November 2017 and December 2018 in Catalonia. The Catalan Health Service provided information from the general population. A descriptive analysis of the beneficiaries’ characteristics was conducted and compared to the general population.Results: The beneficiaries (N = 1,206) were mainly adults with a low level of education, unemployed, with functional disability, and with ≥1 child. Compared with the general population, the beneficiaries were older, had a lower level of education, showed a higher prevalence of functional disability, were less likely to be Spanish, and were more likely to be divorced and unemployed. The beneficiaries were polymedicated, and most were using medication related to the nervous (79%), musculoskeletal (68%), and cardiovascular system (56%) and alimentary tract and metabolism (68%). Almost 19% of beneficiaries used healthcare products. Female beneficiaries were older and more likely to be divorced or widowed, employed, and with children. Compared to men, women were more likely to use medicines for pain and mental disorders. The pediatric group used medications for severe, chronic conditions (heart diseases, autoimmune diseases, conduct disorders, and attention deficit hyperactivity disorder).Conclusion: Patients with severe, chronic, and disabling conditions are affected by pharmaceutical poverty. While the system of copayment remains unchanged, family physicians and pediatricians should explore economic barriers to treatment and direct their patients to resources that help to cover the cost of treatment.

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Impact of initial medication non-adherence on use of healthcare services and sick leave: a longitudinal study in a large primary care cohort in Spain

Cited by 23 publications

References 24 publications

Primary non-adherence to medication and its drivers of in Poland: findings of the analysis of the e-prescription pilot

Primary non-adherence to medication and its drivers of in Poland: findings of the analysis of the e-prescription pilot

A community-based nurse-led medication self-management intervention in the improvement of medication adherence in older patients with multimorbidity: protocol for a randomised controlled trial

Who Suffers From Pharmaceutical Poverty and What Are Their Needs? Evidence From a Spanish Region

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