The Puzzling Problem of Unfilled Prescriptions

Abstract

R esearchers at the Children's Hospital of Chicago sought to determine the rate of unfilled prescriptions among Medicaid-insured patients aged 0 to 24 years who received care at 2 large, urban, pediatric primary care clinics in Chicago over a period of 26 months. One clinic was staffed by residents and their preceptors and the other by residents and full-time academic pediatricians who saw their own patients when not supervising residents. Both clinics used the same electronic medical record (EMR), and midway through the study period both clinics' EMR acquired the functionality of sending prescriptions electronically to a pharmacy (e-prescription). Clinic EMRs were reviewed to obtain data on prescription ordering as well as associated clinical (well child visit vs sick visit) and patient demographic data (race/ethnicity, age, and gender). Prescriptions were divided into 8 medication categories (asthma/allergy, dermatologic, analgesics/antipyretics, oral antiinfectives, topical anti-infectives, nutritional, gastrointestinal, and other). Prescription data were matched with claims data from the Illinois Medicaid database to determine the rate of filled prescriptions.A total of 4,833 unique patients who were given 16,953 prescriptions were included in the study analyses. Most patients were Hispanic or African American and <11 years old. In total, Medicaid claims data indicated that 78.1% of these prescriptions were filled. There was a significant difference in the rate of filled prescriptions by medication category. Oral anti-infectives had the highest rate of being filled (91.2%) and nutritional supplements had the lowest rate (64.7%). African American and Hispanic patients were significantly more likely to fill prescriptions than white patients, and prescriptions given at sick visits were more likely to be filled than prescriptions given at well child visits. E-prescriptions were also significantly more likely to be filled than paper ones.The authors conclude that prescription nonadherence is not uncommon and associated with patient factors, visit type, and prescribing methods. Dr Haischer-Rollo has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The issue of unfilled medications has been a concern of health care providers. Previous studies have shown that overall rates of nonadherence may be as high as 50%. 1-3 The authors of this study document the extent of nonadherence in a Medicaid-insured primary care pediatric population and shed light on the factors that influence the filling of prescriptions. Although previous studies have shown that economics plays a large role in medication adherence, this study only included Medicaid-insured patients and therefore largely removed cost as a barrier. 2,3 The fact that over 20% of prescriptions went unfilled is noteworthy.The results of this study highlight several nondemographic factors associated with prescription nonadherence that deserve furt...