4/11/2023 0 Comments Iscribe medication6, 9, 10 The few studies on PMN have differed in operational definition and methods of measurement. With most medication adherence research to date focused on secondary nonadherence, PMN has been identified as a major research gap. Because a patient needs to fill the prescription twice to be included in the adherence measure, this would mean that the method thus misses instances of PMN when the medication never reaches the patient in the first instance. 7 These secondary nonadherence measures are likely to underestimate the true rate of nonadherence, however, since their method for calculation is to use prescription claims data to identify patients who filled a prescription at least 2 times in the measurement period but then did not refill the medication regularly. Secondary adherence rates are publicly reported for these plans, and incentives, including quality bonus payments, are tied in part to performance on secondary nonadherence measures. The Centers for Medicare & Medicaid Services, for example, has adopted secondary adherence-related measures as part of its star ratings program for Medicare Advantage plans and stand-alone prescription drug plans. Secondary nonadherence has emerged as a major target of quality improvement initiatives. Secondary nonadherence measures prescription refills among patients who previously filled their first prescriptions. This includes prescriptions that patients actually present (or are electronically prescribed), as well as those that never reach the pharmacy. 8 Primary medication nonadherence (PMN) occurs when a new medication is prescribed for a patient, but the patient does not obtain the medication or an appropriate alternative within an acceptable period of time after it was prescribed. Primary and secondary nonadherence are distinct subsets of medication nonadherence. Persistence, by contrast, relates to the time over which a patient continues treatment. 8 They defined adherence as the extent to which a patient takes a medication as prescribed, focusing on frequency, time ingested, and dose. (2013) have proposed separate constructs of medication adherence and persistence. In its 2003 report on medication adherence, the World Health Organization (WHO) noted that “increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments.” 7 This report defined adherence as the “extent to which a person’s behavior-taking medication, following a diet, and/or executing lifestyle changes-corresponds with agreed recommendations from a healthcare provider.” 7 While this concept seems straightforward, defining and measuring medication nonadherence has proven challenging. 2, 3 Poor medication adherence has been linked to worse health outcomes, increased hospitalizations, and increased health care costs. 1 Studies have estimated medication nonadherence rates as high as one third to one half of all patients, leading to an avoidable cost of $290 billion annually in the United States. Poor medication adherence has been increasingly recognized as a major public health issue and a priority for health care reform. Adams has received grant support from Pfizer for adherence research.Īdams and Stolpe were equally involved in all aspects of study design, data collection and interpretation, and manuscript preparation. The views expressed in this article are those of the authors alone and do not necessarily reflect those of their respective employers. PMN literature from 1990 to June 2015 is also reviewed, and existing PMN measures are summarized.ĭISCLOSURES: No funding was received for this article, and the authors declare no conflicts of interest. That new measure, which links electronic prescribing and pharmacy dispensing databases and was developed and approved by the PQA, is described here. Given the limitations of current measures, the Pharmacy Quality Alliance (PQA) convened an expert working group to set parameters for a new industry measure. However, the lack of standardized definitions and measures inhibits the ability to establish the true incidence of this problem or to track changes in PMN rates over time. It is increasingly evident that the public health problem of PMN is widespread. Primary medication nonadherence (PMN) is a subset of this broader subject and occurs when a new medication is prescribed for a patient, but the patient does not obtain the medication, or an appropriate alternative, within an acceptable period of time after it was prescribed.
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