Member Research and Reports

Member Research and Reports

Brown: Prescriber and Pharmacy Variation in Patient Adherence to Five Medication Classes Measured Using Implementation during Persistent Episodes

Dr. Becky L. Genberg, assistant professor of health services, policy and practice in the Brown University School  of Public Health, and colleagues determined the fraction of variance in patient-level medication adherence accounted for by prescribers and pharmacies. The work is published in Pharmacoepidemiology & Drug Safety.

[Photo: Dr. Becky L. Genberg]

Adherence broadly refers to the extent to which patients’ behaviors correspond with agreed recommendations from health care providers. Although advances in the development of drug therapies have dramatically improved patient outcomes, the effectiveness of such medications is limited by suboptimal patient adherence to recommended medication regimens. Non-adherence not only produces poorer individual health outcomes, it is estimated to cost $100–200 billion each year in avoidable hospitalizations. This study examined the proportion of variance in implementation during persistent periods of medication taking attributable to patients, physicians, and pharmacies; and examined whether the proportion of variance varies by medications for different chronic conditions. To meet these objectives, researchers analyzed a large regional commercial pharmacy claims database.

The main finding of this study was that substantial variance in patient implementation was attributable to prescribers and pharmacies. Previous research has largely focused on patient, condition-specific, and therapy-related determinants of medication adherence. The results showed that patient-level factors accounted for the largest proportion of explained variance across all drug classes; however, there has not been much progress in interventions targeted to individual patient factors. That a substantial proportion of the variance observed here was attributable to prescribers and pharmacies suggests that structural interventions targeting multiple levels of influence could have significant and measurable impacts on patient medication use behaviors. The study was published in the May issue of Pharmacoepidemiology & Drug Safety.

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