Filling a prescription is the important first step in medication adherence, but has not been studied in pediatric primary care. The objective of this study was to use claims data to determine the rate of unfilled prescriptions in pediatric primary care and examine factors associated with prescription filling.
This retrospective observational study of pediatric primary care patients compares prescription data from an electronic medical record with insurance claims data. Illinois Medicaid provided claims data for 4833 patients who received 16 953 prescriptions during visits at 2 primary care sites over 26 months. Prescriptions were compared with claims to determine filling within 1 day and 60 days. Clinical and demographic variables significant in univariate analysis were included in logistic regression models.
Patients were 51% male; most (84%) spoke English and were African American (38.7%) or Hispanic (39.1%). Seventy-eight percent of all prescriptions were filled. Among filled prescriptions, 69% were filled within 1 day. African American, Hispanic, and male patients were significantly more likely to have filled prescriptions. Younger age was associated with filling within 1 day but not with filling within 60 days. Prescriptions for antibiotics, from one of the clinic sites, from sick/follow-up visits, and electronic prescriptions were significantly more likely to be filled.
More than 20% of prescriptions in a pediatric primary care setting were never filled. The significant associations with clinical site, visit type, and electronic prescribing suggest system-level factors that affect prescription filling. Development of interventions to increase adherence should account for the factors that affect primary adherence.
Comments
Unfilled presciptions: Variables that account for non-adherence to medical advice
The article by Zweigoron et al in the October issue identified the proportion of unfilled prescriptions in a primary care setting, desribing clinical and demographic factors associated with adhering to medical advice. Why patients do or do not do what we request of them seems to be the essence of the article. An area developed in the 60s that helps to further explain non-adherence to medical advice mentioned in the article can be packaged as the health care belief model. This model examines patient attitudes and beliefs and takes into account the social cognitive and psychological reasons for behavior change, in both health maintenance and illness scenarios. Factors such as culture, family, religion, perceptions of personal responsibility, the family's relationship with the physician (paternalistic Vs equal partners), and self-efficacy regarding one's confidence in carrying out tasks all need to be considered. The way I frame this simply in the clinical setting is to ask two questions: 1) How do you pay for your precscriptions? (in this study, all prescriptions were generated through the EMR and paid for by Medicaid) Drugs are often so expensive that the lack of insurance coverage might preclude the family from filling an expensive prescription; and 2) Is there anything I said today that you don't agree with or can't/won't do? This gets to establishing trust and enabling the parent/child to state if there are issues for any of the above reasons for which they cannot or wil not comply.
Conflict of Interest:
None declared