Address correspondence to Andrew J. Karter, Ph.D., Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612; e-mail: email@example.com. Melissa M. Parker, M.S., Howard H. Moffet, M.P.H., Ameena T. Ahmed, M.D., M.P.H., Julie A. Schmittdiel, Ph.D., and Joe V. Selby, M.D., M.P.H., are with Division of Research, Kaiser Permanente, Oakland, CA. Andrew J. Karter is also with the School of Public Health and Community Health, University of Washington, Seattle, WA.
New Prescription Medication Gaps: A Comprehensive Measure of Adherence to New Prescriptions
Article first published online: 3 JUN 2009
© Health Research and Educational Trust
Health Services Research
Volume 44, Issue 5p1, pages 1640–1661, October 2009
How to Cite
Karter, A. J., Parker, M. M., Moffet, H. H., Ahmed, A. T., Schmittdiel, J. A. and Selby, J. V. (2009), New Prescription Medication Gaps: A Comprehensive Measure of Adherence to New Prescriptions. Health Services Research, 44: 1640–1661. doi: 10.1111/j.1475-6773.2009.00989.x
- Issue published online: 1 SEP 2009
- Article first published online: 3 JUN 2009
- Medication adherence;
- primary adherence;
- diabetes mellitus;
- antihypertensive medication;
- cholesterol-lowering medication;
- antihyperglycemic medication;
- continuous multiple-interval measure of gaps (CMG)
Objective. Describe a novel approach to comprehensively summarize medication adherence.
Data Sources/Study Setting. Kaiser Permanente Northern California Diabetes Registry (n∼220,000)
Study Design. In a new prescription cohort design (27,329 subjects prescribed new medications), we used pharmacy utilization data to estimate adherence during 24 months follow-up. Proportion of time without sufficient medications (medication gaps) was estimated using a novel measure (New Prescription Medication Gaps [NPMG]) and compared with a traditional measure of adherence.
Data Collection/Extraction Methods. Data derived from electronic medical records and survey responses.
Principal Findings. Twenty-two percent of patients did not become ongoing users (had zero or only one dispensing of the new prescription). The proportion of newly prescribed patients that never became ongoing users was eightfold greater than the proportion who maintained ongoing use, but with inadequate adherence. Four percent of those with at least two dispensings discontinued therapy during the 24 months follow-up. NPMG was significantly associated with high out-of-pocket costs, self-reported adherence, and clinical response to therapy.
Conclusions. NPMG is a valid adherence measure. Findings also suggest a larger burden of inadequate adherence than previously thought. Public health efforts have traditionally focused on improving adherence in ongoing users; clearly more attention is needed to address nonpersistence in the very first stages after a new medication is prescribed.