Health care education, delivery, and quality
Patients with asthma who do not fill their inhaled corticosteroids: A study of primary nonadherence

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Background

Adherence to inhaled corticosteroids (ICSs) is known to be poor among patients with asthma; however, little is known about patients who do not fill their ICS prescriptions (ie, primary nonadherence).

Objective

To estimate rates of primary nonadherence and to explore associated factors.

Methods

The study population was members of a large health maintenance organization in southeast Michigan who met the following criteria: age 5 to 56 years; previous diagnosis of asthma; at least 1 electronic prescription for an ICS between February 17, 2005, and June 1, 2006; and at least 3 months follow-up after the ICS prescription. Adherence was estimated by using electronic prescription information and pharmacy claims data. Multivariable stepwise analysis was used to identify factors associated with primary nonadherence compared with adherent patients.

Results

One thousand sixty-four patients met the study criteria and had calculable adherence. Of these patients, 82 (8%) never filled their ICS prescription. Stepwise regression identified the following factors to be associated with an increased likelihood of primary nonadherence: younger age, female sex, African American race-ethnicity, and lower rescue medication use. Factors associated with primary nonadherence differed between race-ethnic groups.

Conclusion

Primary nonadherence was associated with lower baseline rescue medication use, which may reflect lower perceived need for ICS therapy in patients with milder asthma. Rates of primary nonadherence and the factors which influenced this outcome differed by race-ethnicity.

Clinical implications

Understanding patient characteristics associated with primary nonadherence may be important for disease management, because many patients with asthma do not fill their ICS prescriptions.

Section snippets

Study population and setting

This study was approved by the Institutional Review Board at Henry Ford Health System and was in compliance with its Health Insurance Portability and Accountability Act policy. Patients were members of a large health maintenance organization in southeast Michigan and received their care from a large, multispecialty medical group. To be included in the analytic set, patients had to meet the following eligibility criteria: age 5 to 56 years; at least 1 electronic prescription for an ICS between

Results

We identified 1064 patients with asthma who met the inclusion and exclusion criteria (Fig 1). The time difference between receipt of the index ICS prescription and filling of that prescription is shown in Table I. Most patients (90%) filled their prescription within 3 months of receipt, primarily in the first week (83%). However, approximately 3% of patients eventually filled their prescription after a lag time exceeding 3 months and 8% never filled their ICS prescription during follow-up (ie,

Discussion

This is the largest study to examine primary nonadherence to ICSs and is unique in its use of electronic prescription data paired with pharmacy fill data. The latter allowed us to track many more asthma medication prescriptions than previously.4, 5 Our study findings show that the rate of primary nonadherence (ie, never filling) to inhaled corticosteroids was 8%. Even using various criteria for primary nonadherence, our rates of nonfilling were much lower than the value of 30% reported

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  • Cited by (0)

    Supported by a grant from the National Heart Lung and Blood Institute, National Institutes of Health (R01HL079055), and the Fund for Henry Ford Hospital.

    Disclosure of potential conflict of interest: L. K. Williams has received grant support from the National Institute of Allergy and Infectious Diseases and the National Heart, Lung, and Blood Institute, National Institutes of Health. The rest of the authors have declared that they have no conflict of interest.

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