Not obtaining a medication the first time it is prescribed: primary non-adherence to cardiovascular pharmacotherapy

Abstract

Primary medication non-adherence describes the situation when a first prescription for a new medication is never filled. Primary non-adherence is an important, yet understudied aspect of reduced effectiveness of pharmacotherapy. This review summarizes the frequency, impact, reasons, predictors, and interventions regarding primary non-adherence to cardiovascular/cardiometabolic drugs. The current literature reveals a high prevalence of primary non-adherence. The individual risk of primary non-adherence is determined on multiple factors, e.g., primary non-adherence of lipid-lowering drugs is higher compared to antihypertensive medications. However, the overall rate of primary non-adherence is > 10%. Additionally, this review identifies specific areas for research to better understand why patients forgo evidence-based beneficial pharmacotherapy and to explore targeted interventions. At the same time, measures to reduce primary non-adherence—once proven to be effective—may represent an important new opportunity to reduce cardiovascular diseases.

Medication adherence: measurement methods and approaches

“…In clinical trials adherence measures serve as critical tools for the assessment of medication adherence and the identification of causative factors for non-adherence. Figure 1 provides an overview of the phases of medication adherence, with each phase accompanied by appropriate measurement methods (28)(29)(30).…”

“…However, the overall prevalence of primary non-adherence exceeds 10%. As e-prescribing gains prominence in prescription transmission, it is important to have standardized tracking methods for PMN to be able to evaluate the effectiveness of interventions aimed at reducing PMN (29,34,35).…”

Primär- und Sekundärprävention bei Hypercholesterinämie – versorgungsrelevante Unterschiede in der PROCYON-Studie

“…Die Erstverordnung von Lipidsenkern wird von etwa 12 % der Patienten nicht eingelöst (primäre Non-Adhärenz), mehr als z. B. bei Antihypertensiva [24]. Da der/die behandelnde Ärzt*in für die meisten Betroffenen die Hauptinformationsquelle ist, sollte diese besser ausgeschöpft werden.…”

Quality of life in patients with statin intolerance: a multicentre prospective registry study

“… 5 Statin intolerance is associated with primary and secondary non-adherence, discontinuation of treatment, insufficient cholesterol lowering, increased atherosclerotic cardiovascular disease and higher mortality. 6 , 7 Important aspects of the pathogenesis, diagnosis, prognosis, and potential treatment options are unknown despite the clinical importance of statin intolerance. 5 , 8 Due to these uncertainties, slightly different definitions of statin intolerance are used e.g.…”