Electronic prescribing (e-prescribing) decreases prescription errors and enhances coordination between physician and pharmacist, but what has remained unclear is how it affects patient behavior. Now a new study suggests e-prescribing may enhance patient prescription adherence.
In an analysis of nearly 2500 patients, e-prescribing was associated with a significant reduction in primary nonadherence, defined as not filling and picking up all prescriptions within 1 year of the prescription date. report Adewole S. Adamson, MD, assistant professor in the Department of Dermatology at the University of North Carolina in Chapel Hill, and colleagues in an article published online October 26 in JAMA Dermatology.
The researchers compared rates of nonadherence associated with e-prescriptions and paper prescriptions among new patients attending an outpatient dermatology clinic at a large urban hospital.
The risk for primary nonadherence was 17 percentage points lower with e-prescriptions than that associated with paper prescriptions, for a 16% difference after adjusted multivariable analysis, Dr Adamson and colleagues explain. This “represents a 47% reduction in the risk of primary nonadherence for patients who received an e-prescription vs those who received a paper prescription.”
These findings suggest that, as the trend toward e-prescribing grows, clinicians “shouldn’t have to worry that there’s less of a chance for [patients] to fill it than if they were to give them paper,” Dr Adamson said in a podcast interview with JAMA Dermatology.
However, he added, the rate of nonadherence was still more than 15% in people who received e-prescriptions, so “more study is needed to see why patients don’t fill their prescriptions.”
The authors conducted a retrospective record review of patients attending a dermatology clinic through the Parkland Health Plus program, which covers poor, uninsured residents of Dallas County, Texas, and includes a subsidized pharmacy benefit. The study included only new patients, defined as people who had not been to the clinic within the prior 3 years and who had an index visit between January 1, 2011, and December 31, 2013, during which at least one dermatologic medication was prescribed.
The review included 2496 patients, including 1647 women (66%), with a mean age of 47.7 years (standard deviation [SD], 13.2 years). A total of 4318 medications were prescribed, or a mean of 1.7 per patient. The overall rate of primary nonadherence was 31.6%. Of 1693 patients (67.8%) who received paper prescriptions, 492 (29.1%) were completely nonadherent, defined as filling none of their prescriptions. Of the 803 (32.2%) who received e-prescriptions, 127 (15.8%) were completely nonadherent (P <.001).
The difference in adherence rates associated with electronic and paper prescriptions was apparent at all times measured. At 10 days after the index visit, 57.2% of patients given e-prescriptions were fully adherent compared with 46.2% of patients given paper prescriptions. Similarly, at 60 days, the proportion of full adherence was 78.2% vs 60.8%, respectively (P < .001).
Nonadherence also showed a relationship with other patient characteristics, the authors note. It was highest among the youngest patients: of 231 patients younger than 30 years, 67 (29%) were nonadherent compared with 295 (26.8%) of 1100 people aged 30 to 49 years and 237 (21.6%) of 1096 people aged 50 to 69 years. Nonadherence climbed slightly among patients aged 70 years or older, at 20 (29%) of 69 patients (P <.001).
People who listed their primary language as English also had the highest rates of nonadherence (25.7% for English-speakers vs 24.0% for Spanish speakers and 18.5% for those who spoke other languages; P < .001). Similarly, nonadherence was observed in 30.7% of non-Hispanic white patients, 23.2% of Hispanic white patients, 24.5% of black patients, and 22.3% of patients of other races or ethnicities (P = .007).
Full adherence was highest among Hispanic patients, at 70.3%. These findings differ from other studies, which have shown higher rates of primary nonadherence among Hispanic patients and might reflect the fact that “Parkland Memorial Hospital has the infrastructure to accommodate the needs of its high volume of Spanish-speaking patients,” the authors write.
Among patients who received one prescription, primary adherence was 66.9%. That increased to 71.2% with two prescriptions and 73.6% with three prescriptions, but dropped to 60.2% (77 of 128) when four prescriptions were given, the authors note. They suggest that filling multiple prescriptions may become “financially burdensome.”
This study was not designed to identify reasons for patient nonadherence, the authors warn. Also, they studied urban, low-income patients who received a subsidized pharmacy benefit at one subspecialty clinic, so the results may not be generalizable to other patient populations.
Nevertheless, these findings suggest that primary nonadherence “is a common and pervasive problem,” they conclude. “Steps should be taken to better understand why primary nonadherence happens and how it can be improved.”