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Refill Adherence to Long-Term Drug Treatment with a Focus on Asthma/COPD Medication
Uppsala University, Medicinska vetenskapsområdet, Faculty of Pharmacy, Department of Pharmacy.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Most patients are non-adherent with their medication sometimes, i.e. that they do not always use their medicines as prescribed. This might result in both under- and overuse and can lead to therapy failure, resulting in both unnecessary suffering and high costs. Therefore, medication adherence should be as high as possible.

The aims of this thesis were to investigate the refill adherence to long-term drug treatment, especially for patients with asthma and chronic obstructive pulmonary disease (COPD), and to study treatment gaps for patients with undersupply and drug costs for patients with oversupply. Further aims were to compare different methods for assessing refill adherence and analyse whether the same patient has the same refill adherence pattern to two different chronic drug treatments, i.e. diabetes and asthma/COPD.

The thesis shows that satisfactory refill adherence (80-120% of the prescribed dose) was 57% for repeat prescriptions with long-term drug treatment; undersupply was 21% and oversupply 22%. Patients with undersupply were without drugs more than half of the prescribed treatment time and the median oversupply for 90-100 days dispensation interval was 28 days. Patients who were exempt from charges had significantly higher oversupply than non-exempt patients and that leads to unnecessary cost for society. The level of satisfactory refill adherence for repeat prescriptions dispensed for asthma/COPD was on average 30%. The same low level was displayed for the elderly, where undersupply was more common than oversupply.

Assessments of refill adherence during a one-year period gave the same results irrespective of whether the repeat prescriptions were from an individual pharmacy record database or were manually collected at a pharmacy.

Patients with concomitant use of diabetes and asthma/COPD drugs do not have the same dispensation pattern for both drug types.

The introduction of patient profiles as a new approach to complement the calculated refill adherence needs to be further studied in larger and more divergent populations. In the future, the new national pharmacy record database in Sweden has opened up for larger studies and will be valuable when studying patterns of drug utilization.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2007. , p. 75
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Pharmacy, ISSN 1651-6192 ; 60
Keywords [en]
Community pharmacy services, asthma, chronic disease, COPD, diabetes, pharmacy record database, prescription, refill adherence
Keywords [sv]
Samhällsfarmaci
Identifiers
URN: urn:nbn:se:uu:diva-8094ISBN: 978-91-554-6931-3 (print)OAI: oai:DiVA.org:uu-8094DiVA, id: diva2:170487
Public defence
2007-09-21, B7:113a, Uppsala Biomedicinska centrum, Husargatan 3, Uppsala, 09:15
Opponent
Supervisors
Available from: 2007-09-03 Created: 2007-09-03Bibliographically approved
List of papers
1. Repeat prescriptions: refill adherence in relation to patient and prescriber characteristics, reimbursement level and type of medication
Open this publication in new window or tab >>Repeat prescriptions: refill adherence in relation to patient and prescriber characteristics, reimbursement level and type of medication
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2005 In: Eur J Public Health, ISSN 1101-1262, Vol. 15, no 6, p. 621-626Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-96045 (URN)
Available from: 2007-09-03 Created: 2007-09-03Bibliographically approved
2. Refill non-adherence to repeat prescriptions leads to treatment gaps or to high extra costs
Open this publication in new window or tab >>Refill non-adherence to repeat prescriptions leads to treatment gaps or to high extra costs
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2007 (English)In: Pharmacy World & Science, ISSN 0928-1231, E-ISSN 1573-739X, Vol. 29, no 1, p. 19-24Article in journal (Refereed) Published
Abstract [en]

Objective: To determine the nature and extent of undersupply and the economic consequences of oversupply of medication among non-adherent patients. Methods: This study used copies of repeat prescriptions (=multiple dispensations), collected during 1 week in 2002 at 16 Swedish community pharmacies. For patients with a refill adherence below 80%, treatment gaps were defined as the number of days they had no drug available. The cost of drug oversupply (i.e., refill adherence >120%) was calculated from the prices of the drug packages dispensed. Results: The number of collected repeat prescriptions was 3,636. The median of treatment gaps among patients with a refill adherence below 80% was 53 days per 90–100 days treatment period and the corresponding median for oversupply was 40 days. The cost of oversupply for exempt patients (i.e., patients who have paid 1,800 SEK (€ 196; US$ 243) per year for medicines) was 32,000 SEK (€ 3,500; US$ 4,300) higher than for non-exempt patients. An extrapolation to all Sweden indicates that exemption from charges leads to an additional oversupply of about 142 million SEK (€15 million; US$ 19 million) per year above that of non-exempt patients. Conclusion: Both undersupply and oversupply of prescribed medicines are common in Sweden. Patients with a refill adherence below 80% seem to have less than half of the prescribed treatment available. Oversupply or drug stockpiling occurs more frequently among exempt than among non-exempt patients, and this oversupply leads to high unnecessary costs.

Keywords
Costs, Exemption from charges, Oversupply, Refill adherence, Repeat prescriptions, Treatment gaps, Undersupply
National Category
Pharmaceutical Sciences
Identifiers
urn:nbn:se:uu:diva-96046 (URN)10.1007/s11096-005-4797-8 (DOI)
Available from: 2007-09-03 Created: 2007-09-03 Last updated: 2018-01-13Bibliographically approved
3. Refill adherence for patients with asthma and COPD: comparison of a pharmacy record database with manually collected repeat prescriptions
Open this publication in new window or tab >>Refill adherence for patients with asthma and COPD: comparison of a pharmacy record database with manually collected repeat prescriptions
2007 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 16, no 4, p. 441-448Article in journal (Refereed) Published
Abstract [en]

PurposeTo compare refill adherence data based on two different methods of data capturing, that is, manually collected repeat prescriptions and a pharmacy record database.MethodsThe study comprised a comparison of adherence data from manually collected repeat prescriptions of asthma and chronic obstructive pulmonary disease (COPD) drugs with fixed dosages dispensed in 2002 and the corresponding data from a pharmacy record database. Data were collected in the county of Jämtland in Sweden. Refill adherence was calculated for the different collection methods.ResultsData from 285 manually collected repeat prescriptions for asthma/COPD drugs for 2002 showed that 35% of the prescribings had been satisfactory refilled, while 42% showed an undersupply and 23% an oversupply. The pharmacy record database had 490 prescribings for asthma/COPD drugs registered in 2002, 28% of these had a satisfactory refill adherence, while 43% showed an undersupply, and 29% an oversupply. Based on the database it could be shown that 11% of the individuals had used more than one repeat prescription of the same medicine during 2002. Based on the pharmacy record database for 1999-2002, it was shown that 29% of the prescribings had been satisfactory refilled whereas undersupply increased (53%) and oversupply decreased (18%) as compared to the 1-year data.ConclusionsRefill adherence determined from manually collected repeat prescriptions and from a pharmacy record database did not differ for a 1-year period. Four-year data might give a better overview of patients' refill adherence than 1-year data.

Keywords
repeat prescriptions, pharmacy record database, refill adherence, asthma, COPD
National Category
Pharmaceutical Sciences
Identifiers
urn:nbn:se:uu:diva-96047 (URN)10.1002/pds.1321 (DOI)17006959 (PubMedID)
Available from: 2007-09-03 Created: 2007-09-03 Last updated: 2018-01-13Bibliographically approved
4. Refill adherence by the elderly for asthma/COPD drugs dispensed over a ten-year period
Open this publication in new window or tab >>Refill adherence by the elderly for asthma/COPD drugs dispensed over a ten-year period
(English)Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:uu:diva-96048 (URN)
Available from: 2007-09-03 Created: 2007-09-03 Last updated: 2011-04-26Bibliographically approved
5. Adherence to multiple drug therapies: Refill adherence to concomitant use of diabetes and asthma/COPD medication
Open this publication in new window or tab >>Adherence to multiple drug therapies: Refill adherence to concomitant use of diabetes and asthma/COPD medication
2007 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 16, no 10, p. 1120-1128Article in journal (Refereed) Published
Abstract [en]

PurposeTo investigate whether patients with drugs for two chronic diseases, type 2 diabetes and asthma/chronic obstructive pulmonary diseases (COPD), showed the same refill adherence pattern in relation to their drug treatments during a 3-year period.MethodsPatients 50 years and older who had been dispensed diabetes and asthma/COPD drugs in the county of Jämtland during 2001-2003 were included. The refill adherence was calculated based either on prescribed dosage or defined daily dose (DDD). A patient profile graph for each patient was constructed including the date of each dispensation and the time period covered by the dispensed drugs. For each patient, the dispensation pattern and the treatment persistency over time were determined.ResultsIn total, 56 patients were included in the study. Satisfactory refill adherence was found for 68% of the repeat prescriptions for diabetes drugs and for 42% of the repeat prescriptions for asthma/COPD drugs. About half (52%; 29/56) of the patients showed the same dispensation patterns for both diabetes and asthma/COPD drugs, and 86% (25/29) of these patients had a satisfactory refill adherence. However, there was no correlation or agreement regarding the dispensation patterns for diabetes and asthma/COPD drugs.ConclusionsPatients showed higher refill adherence for their diabetes drugs than their asthma/COPD drugs. Our hypothesis that patients with satisfactory refill adherence to antihyperglycaemic drugs would also have satisfactory refill adherence to asthma/COPD drugs, was not supported.

Keywords
refill adherence, pharmacy record database, diabetes, asthma, COPD
National Category
Pharmaceutical Sciences
Identifiers
urn:nbn:se:uu:diva-96049 (URN)10.1002/pds.1433 (DOI)000250430400010 ()17566142 (PubMedID)
Available from: 2007-09-03 Created: 2007-09-03 Last updated: 2018-01-13Bibliographically approved

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