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The Role of Pre..

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Patient outcomes can be greatly affected by non-adherence to medication regimens.Negative outcomes associated with non-adherence can include increased morbidity and mortality, as well as increased healthcare related costs.2 Several studies have been performed to evaluate the prevalence of “primary non-adherence”.2,3 Primary non-adherence occurs when a patient is prescribed a medication by a practitioner but never has the prescription filled at a pharmacy, and therefore never receives the medication.3

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A recent study was commissioned to evaluate the prevalence of non-adherence that results from “prescription abandonment”.4 Unlike primary non-adherence where a prescription order is never filled, prescription abandonment occurs when a medication is in fact filled by a pharmacy, but is never picked up by the patient.The end result is similar; the patient does not receive medication that was prescribed to treat an underlying condition. However, the costs of prescription abandonment can greatly exceed those from primary non-adherence in that a pharmacist’s time and resources have been used to prepare the medication. Also, additional employee time is necessary to return medications to stock reserves that have not been picked up by patients.

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In this study, Shrank et al. found that approximately 3.27% of all prescriptions are abandoned.4 Several factors were identified that would indicate a higher likelihood of prescription abandonment.4 These factors, primarily socioeconomic in nature, include; higher prescription copayments, higher number of prescriptions filled, prescription indication, and how the prescription was delivered to the pharmacy (e.g., handwritten, electronic, phone-in).A prescription carrying a co-pay of $50 had a prevalence of 4.5% abandonment, while a $10 co-pay was only abandoned 1.4% of the time. Also, electronic prescriptions were more commonly abandoned that any other delivery method, which may indicate a lack of patient communication.4

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The researchers identified patterns of prescription abandonment among drug classes as well. For instance, one of the most commonly abandoned prescription classes were the proton pump inhibitors (PPIs) at 2.6%.4 This is likely due to current cost-effectiveness and availability of PPIs over-the-counter, rather than via prescription. Alternatively, opiates had the lowest incidence of prescription abandonment at 1.0%, likely due to the unavailability of comparable medications over-the-counter, but also due to the propensity for these medications to be abused or diverted.4 

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Clinicians can play an integral role in patient compliance and adherence to medication regiments. While prescription abandonment is only one issue that can lead to non-adherence, reducing the occurrence of abandonment may lead to increased medication compliance. One way to accomplish this is by identifying individuals more prone to abandoning a prescription and counseling these patients more aggressively on proper use of their medications. While this will not eliminate prescription non-adherence, it is a step in the right direction.

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1. Balkrishnan R. The importance of medication adherence in improving chronic-disease related outcomes: what we know and what we need to further know. Med Care 2005;43(6):517-20.   [PubMed: 15908845]
2. Shah NR, Hirsch ...

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