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>>For Doctors >>May 2014

Primary Non-Adherence:
Greatest for New Prescriptions Treating Chronic Disease

Michael Fischer, MD and colleagues followed 195,930 e-prescriptions made by 1,217 prescribers.1  On average, 22% were not even filled.  The rate was highest among prescriptions for new medications treating chronic diseases: hypertension (28.4%), hyperlipidemia (28.2%), and diabetes (31.4%).  A study by the insurance company Aetna found even worse primary non-adherence rates among patients recently discharged from the hospital after an episode of acute myocardial infarction. Sixty-four to forty-nine percent of those patients did not fill their prescriptions.2   Of course, filling the prescription is only the first part of adherence, so it is likely that overall non-adherence rates are much higher. 

In addition to compromising patient health, the non-adherence patterns generate a considerable burden on our health care system.  One-third to 69% of medication-related hospital admissions / readmissions are caused by non-adherence.3  As corporate health insurance premiums soar, an estimated 20% to 25% of those expenses stem from non-adherence.4  In 2009, the New England Healthcare Institute estimated that non-adherence costs the U.S. healthcare system $290 billion per year.5  

It is possible that cost is only one, small part of the non-adherence puzzle.  In the Aetna study of myocardial infarction patients, Aetna compared patients with normal deductibles for medication to patients with experimental full coverage of meds.  Those with full-coverage of meds only improved their medication adherence 4% to 6%.2  However, Aetna did find even that small improvement cost-effective and embarked on plans to target certain prescriptions for lower cost-sharing.

Various strategies for improving the non-adherence epidemic have been proposed.  Partnerships with pharmacies, predictive modeling, and advanced pillboxes are popular topics.  When you suspect a likelihood of non-adherence from a homebound patient, a partnership with Ideal Home Care can prove productive.  Whenever you prescribe a new medication, your assessment of a need for more education alone satisfies Medicare’s skilled need requirement.  Various studies show nurse follow-up improving patient adherence to prescribed diets and medications.6-15 

Ideal Home Care is positioned well to be your partner for improving patient adherence.  Making multiple visits to the homes of your patients over the course of weeks or months, our nurses can reinforce your teaching, follow up to ensure adherence, identify barriers to adherence, and implement a variety of plans to overcome those barriers.  Ideal nurses will address understanding and motivation, transportation barriers, and solutions to forgetfulness.  With access to the home environment, our nurses can recruit and train family members for assistance and use the home environment to set up better, personalized reminder systems. 



  1. Fischer M, Stedman M, Lii J, et al. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010; 25: 284-290.
  2. Choundhry N, Avorn J, Glynn R, et al. Full coverage of preventive medications after myocardial infarction. N Engl J Med. 2011; 365: 2088-2097.
  3. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005; 353: 487-489.
  4. 10th Annual survey of large employers: Watson Wyatt Worldwide and National Business Group on Health, March 2005.
  5. New England Health Institute (NEHI). “Thinking outside the pillbox: a system-wide approach to improving patient medication adherence for chronic disease.” August 2009.
  6. Gates B, Setter S, Corbett C, et al. A comparison of educational methods to improve NSAID knowledge and use of a medication list in an elderly population. Home Health Care Management & Practice. 2005; 17 (5): 403-10.
  7. Meredith S, Feldman P, Frey D, et al. Improving medication use in newly admitted home health care patients: a randomized controlled trial. J Am Geriatr Soc. 2002; 50 (9): 1484-91.
  8. Fulmer T, Feldman P, Kim T, et al. An intervention study to enhance medication compliance in community-dwelling elderly individuals. J Gerontol Nurs. 1999; 25 (8): 6-14.
  9. Costa L, Poe S. Challenges in posthospital care: nurses as coaches for medication management. J Nurs Care Qual. 2011; 26 (3): 243-251.
  10. Patel N, Balady G. The Rewards of Good Behavior. Circulation. 2010; 121: 733-735.
  11. Twardella D, Merx H, Hahmann H, et al. Long term adherence to dietary recommendations after inpatient rehabilitation: prospective follow up study of patients with coronary heart disease. Heart. 2006; 92 (5): 635-40.
  12. U.S. Preventive Services Task Force. Behavioral counseling in primary care to promote a healthy diet: recommendations and rationale. Rockville MD: Agency for Healthcare Research and Quality, 2002.
  13. McCarron D, Reusser M. Cardiovascular Risk Reduction Dietary Intervention Trial. Drug Benefit Trends. 2000; 12(5): 42-48.
  14. West JA, Miller NH, Parker KM, et al. A comprehensive management system for heart failure improves clinical outcomes and reduces medical resource utilization. Am J Cardiol. 1997; 79:58-63.
  15. Stewart S, Pearson S, Horowitz JD. Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care. Arch Intern Med. 1998;158:1067-1072.





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