Impact of Pharmaceutical Underutilization: A Study of Insurance Drug Claims Data

Harrow, Brooke; Strom, Brian L.; Gans, John A.

doi:10.1016/s1086-5802(16)30254-6

Cited by 6 publications

(5 citation statements)

References 12 publications

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“…Underuse is defined as a reduction of the apparent daily use versus a standard dose of a medication that is indicated for the treatment or prevention of a disease or condition (Lipton et al 1992; Harrow et al 1997). Improper use or inappropriate use is confirmed by determining whether a drug is ineffective, not indicated, or if there is unnecessary duplication of therapy (Steinman et al 2006).…”

Section: Underuse Overuse and Improper Usementioning

confidence: 99%

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Medication adherence issues in patients treated for COPD

Restrepo

Alvarez

Wittnebel

et al. 2008

COPD

355

348

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Although medical treatment of COPD has advanced, nonadherence to medication regimens poses a significant barrier to optimal management. Underuse, overuse, and improper use continue to be the most common causes of poor adherence to therapy. An average of 40%–60% of patients with COPD adheres to the prescribed regimen and only 1 out of 10 patients with a metered dose inhaler performs all essential steps correctly. Adherence to therapy is multifactorial and involves both the patient and the primary care provider. The effect of patient instruction on inhaler adherence and rescue medication utilization in patients with COPD does not seem to parallel the good results reported in patients with asthma. While use of a combined inhaler may facilitate adherence to medications and improve efficacy, pharmacoeconomic factors may influence patient’s selection of both the device and the regimen. Patient’s health beliefs, experiences, and behaviors play a significant role in adherence to pharmacological therapy. This manuscript reviews important aspects associated with medication adherence in patients with COPD and identifies some predictors of poor adherence.

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Section: Underuse Overuse and Improper Usementioning

confidence: 99%

“…The most common type of nonadherence in patients with COPD is underuse (Harrow et al 1997; George et al 2005). By contrast, improper use is the most frequent type of nonadherence in patients older than 65 years with polypharmacy (taking 2 or more medications) (Steinman et al 2006).…”

Section: Underuse Overuse and Improper Usementioning

confidence: 99%

Medication adherence issues in patients treated for COPD

Restrepo

Alvarez

Wittnebel

et al. 2008

COPD

355

348

View full text Add to dashboard Cite

show abstract

“…There are also three types of non-adherence to therapy: underuse, overuse and improper use. Underuse is a decrease of recommended daily dose of treatment (11,12). Improper use is the case when a drug is ineffective, not indicated or unnecessary duplication (13).…”

Section: Discussionmentioning

confidence: 99%

“…While in asthma the main form of adherence problem is due to overuse of short-acting beta agonists, in COPD the most common type of non-adherence is underuse (12,14). Improper use is also found in COPD patients who are older, have comorbidities and must take two or more medications (13).…”

Section: Discussionmentioning

confidence: 99%

INSPIRO project – Educational intervention against non-adherence to inhalation therapy for Romanian asthma and COPD patients

et al. 2020

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Background In the management of chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD), adherence to therapy represents a key to success. Objective The objective was to increase adherence to treatment through the development of educational intervention (EI) for asthma and COPD, addressed to patients and general practitioners (GPs). The educational programme includes group educational sessions and educational materials and was carried out in five Romanian hospitals. The results were assessed through Test of Adherence to Inhalers (TAI) questionnaire. Results Of note, 347 GPs and 435 patients were included. Seventy-six per cent of the GPs considered that the main causes of non-adherence are the disease misunderstanding, difficulty of using inhaled medication, fear of adverse effects, the patient’s conviction that no medicine is useful for his illness and financial nature (20%). Fifty-five per cent of surveyed GPs believed that their patients always or most of the time adhere to inhaled therapy but 57% of the same surveyed GPs checked the inhalation technique of their patients sometimes, rarely or never. Only 44% of the GPs discussed with the pulmonologist about their patient’s disease. Before the EI, only 32% of patients had a good adherence score to therapy; this percentage increases to 57% after EI. The most common reasons for non-adherence were: patient forgets to administer his inhalation medication daily (49%), fear of adverse effects (33%), belief that medication is useless (26%), and fear that inhalation medication affects everyday life of the patient (24%). Nearly half of the patients (47%) give up medication when they feel better. Forty per cent of patients drop off inhalation treatments due to financial reasons. The most influenced behaviours as a result of the EI were psychological component (85%), fear of the adverse events (82%) and social component (79%). Conclusions The non-adherence to therapy remains a real problem in asthma and COPD patients in our study group, but EI had positive effects. Extending medical education programmes for patients focused on main reasons of poor adherence, such as forgetting to take medication daily, use of inhalator devices, not understanding their disease, may significantly increase adherence to inhalation treatment.

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“…Studies have shown that confidence in drug therapy could be low among patients with COPD [ 45 ], and medication underuse is the most prevalent type of nonadherence with this illness [ 46 ]. Rather than emphasizing the (often unfounded) risks, manufacturers should aim to encourage adherence by describing the medication's potential benefits.…”

Section: Discussionmentioning

confidence: 99%

Readability and Suitability of COPD Consumer Information

Fullmann

Blackburn

Fenton

et al. 2017

Canadian Respiratory Journal

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Background Information leaflets have been shown to positively or negatively impact adherence, depending on their content. The objective of this study was to perform an appraisal of the consumer information provided in COPD inhaler monographs. Methods COPD inhalers were identified from the Health Canada Drug Product Database. Medication information and instructions for inhaler use were analyzed for readability by seven formulas, with an acceptability threshold of grades 6–8. Three researchers rated suitability using a modified Suitability Assessment of Materials (SAM) tool and assessed leaflets for explicit warnings. Results Twenty-six inhalers with a COPD indication were evaluated. Medication information sections were rated as “difficult to read” or “hard,” and 85% (22/26) had a reading level above grade 8. The instructions for inhaler use were rated as “easy” or “fairly easy” to read and 63% (16/26) met the threshold by all formulas. While all leaflets achieved superior suitability ratings, extreme warnings included risk of premature death (n = 12), risks of serious injury (n = 26), serious interactions (n = 26), and statements that convey a serious consequence to therapy (n = 26). Conclusion While COPD information leaflets in Canada performed well in terms of readability and suitability, overemphasis on side effects, warnings, and precautions may contribute to patient fear and nonadherence.

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Impact of Pharmaceutical Underutilization: A Study of Insurance Drug Claims Data

Cited by 6 publications

References 12 publications

Medication adherence issues in patients treated for COPD

Medication adherence issues in patients treated for COPD

INSPIRO project – Educational intervention against non-adherence to inhalation therapy for Romanian asthma and COPD patients

Readability and Suitability of COPD Consumer Information

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