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Study: Many older Canadians don’t always fill new prescriptions

The study showed that roughly one in six new prescriptions were not being filled: 'Understanding primary nonadherence is important as it is the first point at which patients fail to initiate their medication therapy which could lead to substantial health implications'

A study of Canadian patients in primary health care showed that as many as 17 per cent of them failed to get new drug prescriptions filled within six months of the prescription date.

The study was published this week in the Canadian Medical Association Journal (CMAJ) and examined the actions of more than 34,000 patients between January 2013 and April 2019 in British Columbia. 

The study also found that the incidence of patients not filling new prescriptions has been understudied in the general population and not enough is known. Previous studies on adherence to prescriptions have focused on why patients failed to fill secondary and follow-up prescriptions.

The study was authored by Seraphine Zeitouny, Lucy Cheng, Sabrina T. Wong, Mina Tadrous, Kimberlyn McGrail and Michael R. Law, representing researchers and scientists associated with the Centre for Health Services and Policy Research, University of British Columbia, Vancouver; the Leslie Dan Faculty of Pharmacy, University of Toronto; and Women’s College Research Institute at Women’s College Hospital, Toronto.

The researchers said they were able to link prescribing data from primary care electronic medical records to comprehensive pharmacy dispensing claims in British Columbia to estimate primary nonadherence.

The findings were that more than 150,000 new prescriptions for 34,243 patients were never filled.  The study said the highest numbers were for drugs prescribed on an "as-needed" basis, which included such prescriptions as topical corticosteroids (35.1 per cent) and antihistamines (23.4 per cent), said the study. 

The study also showed that nonadherence for new prescriptions did not happen as much with younger patients. The study found that patients 65 and older, and with multiple prescriptions, were more likely not to get new prescriptions filled in a timely manner.

The problem of patients not filling prescriptions is complex, said the study, which added that it "contributes to suboptimal health outcomes and poses substantial challenges and financial burdens on the healthcare system."

The study said the problem is not new in Canada. and additional research would be helpful. 

"In Canada, primary nonadherence constitutes a major research gap, and the behaviour of not filling prescriptions for new medications is not well understood. An early study on primary nonadherence was conducted in primary care in Quebec and found that nearly one-third of incident prescriptions remain unfilled. Others were limited to investigating primary nonadherence in disease-specific cohorts.

"Understanding primary nonadherence is important as it is the first point at which patients fail to initiate their medication therapy which could lead to substantial health implications. Nevertheless, this behaviour may be appropriate for some medications prescribed on an as-needed basis, including the “wait-and-see approach.” 

In conclusion, the authors wrote that healthcare providers could focus more attention on older patients with multiple prescriptions. 

"Interventions to address primary nonadherence could prioritize targeting older patients with multiple medication use and within the first two weeks of the prescription order. Future research should examine the impact of primary nonadherence to chronic medications on patient outcomes and health system effects."

The full text of the study can be found online here.

Len Gillis covers health care for Village Media's

Len Gillis

About the Author: Len Gillis

Graduating from the Journalism program at Canadore College in the 1970s, Gillis has spent most of his career reporting on news events across Northern Ontario with several radio, television and newspaper companies. He also spent time as a hardrock miner.
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