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Refill non-adherence to repeat prescriptions leads to treatment gaps or to high extra costs
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
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2007 (English)In: Pharmacy World & Science, ISSN 0928-1231, E-ISSN 1573-739X, Vol. 29, no 1, 19-24 p.Article 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.

Place, publisher, year, edition, pages
2007. Vol. 29, no 1, 19-24 p.
Keyword [en]
Costs, Exemption from charges, Oversupply, Refill adherence, Repeat prescriptions, Treatment gaps, Undersupply
National Category
Pharmaceutical Sciences
URN: urn:nbn:se:uu:diva-96046DOI: 10.1007/s11096-005-4797-8OAI: oai:DiVA.org:uu-96046DiVA: diva2:170483
Available from: 2007-09-03 Created: 2007-09-03 Last updated: 2010-04-07Bibliographically approved
In thesis
1. Refill Adherence to Long-Term Drug Treatment with a Focus on Asthma/COPD Medication
Open this publication in new window or tab >>Refill Adherence to Long-Term Drug Treatment with a Focus on Asthma/COPD Medication
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. 75 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Pharmacy, ISSN 1651-6192 ; 60
Community pharmacy services, asthma, chronic disease, COPD, diabetes, pharmacy record database, prescription, refill adherence, Samhällsfarmaci
urn:nbn:se:uu:diva-8094 (URN)978-91-554-6931-3 (ISBN)
Public defence
2007-09-21, B7:113a, Uppsala Biomedicinska centrum, Husargatan 3, Uppsala, 09:15
Available from: 2007-09-03 Created: 2007-09-03Bibliographically approved

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