Standardizing Primary Medication Nonadherence Measures

Primary medication nonadherence is a widespread public health problem; however, the subject lacks standardized definitions and measures making it difficult to establish the true extent of the problem and track changes over time.

In a study published in Journal of Managed Care and Specialty Pharmacy (JMCP) Alex Adams, PharmD, MPH, and Samuel Stolpe, PharmD, compiled set parameters for a new industry measure.

Study Objectives

Primary and secondary nonadherence are distinct subsets of medication non-adherence.

• 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.
• Secondary non-adherence measures prescription refills among patients who previously filled their first prescriptions.

Since most medication adherence research to date has focused on secondary non-adherence, PMN has been identified as a major research gap. There are lack of standardized measures and limited understanding of its true extent. Adams and Stolpe have tried to establish more standardized PMN measures so that it might be helpful in benchmarking and quality improvement initiatives.

For the study, a literature review was conducted using Google Scholar and PubMed databases, covering the time period from 1990 to June 2015. Search terms included “primary non-adherence,” “primary medication non-adherence,” “medication non-redemption,” “medication non-fulfillment,” “primary non-compliance,” “first-fill prescriptions,” and “newly initiated drug therapy.”

Clarity on Terminology

The most frequently used terms (in 77% of all studies) to describe PMN were “primary medication nonadherence” or “primary adherence.” Three studies used the term “prescription abandonment” for the same. But PMN is not the same as prescription abandonment. “Prescription abandonment” is traditionally used in studies as a broader term than PMN and occurs whenever a prescription is filled by a pharmacy but not claimed by the patient.

“PMN occurs when a new medication is prescribed for a patient, but the patient does not obtain the medication, or appropriate alternative, within an acceptable period of time after it was prescribed,” the authors wrote.

Standardization Leads to Effectiveness

Poor medication adherence is an increasing public health issue that has been linked to worse health outcomes, increased hospitalizations, and increased health care costs. Medication nonadherence is responsible for a cost of $290 billion annually in the United States.

It is very important to develop a consensus-based definition and quality measure of PMN. Doing that would enable one step closer towards consistent measurement of this phenomenon. Especially since e-prescribing is becoming the leading mode of prescription transmission, it is important to have standardized methods of tracking PMN in order to study the effectiveness of interventions to reduce PMN.