Patient outcomes can be greatly affected by non-adherence to medication regimens.1 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
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.5 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.
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).5 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
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
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.
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.