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

Abstract

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.

Prevalence and Age Structure of Polypharmacy in Poland: Results of the Analysis of the National Real-World Database of 38 Million Citizens

“…The actual degree of drug use is modified by patient adherence, which varies from over-to underuse of prescribed drugs. Fortunately, the data analyzed by us, i.e., dispensation data, are not biased by primary non-adherence, which was recently found, in other studies conducted by our group, to reach the overall level of 20.8% (Kardas et al, 2019), with some drug groups reaching even higher values (e.g., 31.3% in antihistamines (Kardas et al, 2020)). On the other hand, real-world drug use is affected by secondary non-adherence, which in Poland in some cases reached the level of over 80% (Kardas, 2011).…”

Primary non-adherence to inhaled medications measured with e-prescription data from Poland

“…Using the data of highest possible quality available to date, that originated from a nationwide e-prescription database, a specific level of primary non-adherence to inhaled medications in Poland was proven. The nonadherence to these drugs was lower than obtained in our previous study on drivers of general non-adherence in Poland, where for drugs in 6 major areas (antidiabetic, antithrombotic, cardiovascular, cholesterol medications, antibiotics and psychiatric drugs) the primary nonadherence was 20.8% [31]. Also, it was lower than of that for antihistamine drugs, for which the level of primary non-adherence was 21% [32].…”

Primary non-adherence to inhaled medications measured with e-prescription data from Poland

“…Using the data of highest possible quality available to date, that originated from a nationwide e-prescription database, a speci c level of primary non-adherence to inhaled medications in Poland was proven. The non-adherence to these drugs was lower than obtained in our previous study on drivers of general non-adherence in Poland, where for drugs in 6 major areas (antidiabetic, antithrombotic, cardiovascular, cholesterol medications, antibiotics and psychiatric drugs) the primary non-adherence was 20.8% (31). Also, it was lower than of that for antihistamine drugs, for which the level of primary nonadherence was 21% (32).…”