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Adherence to multiple drug therapies: Refill adherence to concomitant use of diabetes and asthma/COPD medication
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
2007 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 16, no 10, 1120-1128 p.Article 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.

Place, publisher, year, edition, pages
2007. Vol. 16, no 10, 1120-1128 p.
Keyword [en]
refill adherence, pharmacy record database, diabetes, asthma, COPD
National Category
Pharmaceutical Sciences
URN: urn:nbn:se:uu:diva-96049DOI: 10.1002/pds.1433ISI: 000250430400010PubMedID: 17566142OAI: oai:DiVA.org:uu-96049DiVA: diva2:170486
Available from: 2007-09-03 Created: 2007-09-03 Last updated: 2011-01-19Bibliographically 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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