Abstract 18059: Primary Non-Adherence to Statin Medications in a Managed Care Organization
Background: Primary non-adherence to medication therapy has long been recognized. Integrated healthcare delivery systems with electronic health records (EHR) are able to track prescription orders and dispense dates, improving the ability to identify primary non-adherence. We analyzed a cohort of patients who received a new statin prescription to determine the timing of first fills and the rate of primary non-adherence.
Methods: Kaiser Permanente Southern California (KPSC) is a non-profit group model health maintenance organization serving over three million members. Study participants were 24 years and older with 12 months of continuous membership prior to the statin order. Patients with a new order for a statin prescription between December 1, 2009 and February 28, 2010 were identified through the EHR. New orders were defined if the patient had no statin prescriptions in the previous 12 months. Prescriptions sold through KPSC pharmacies were linked with the EHR orders. We performed a descriptive analysis of patients who did and did not pick-up their new statin prescription using information on age, gender, chronic conditions, utilization of other medications and healthcare resources.
Results: During the study window, we identified 20,329 patients with a new statin order; 3964 (19.5%) of patients did not pick-up their statin prescription within 60 days of the order date. For patients who did pick-up their statin prescription, 83.5% did so within 7 days and 94.7% did so within 21 days. Primary non-adherent patients were younger (55.6±12 vs 57.7±13 years, p < 0.001), had lower LDL-C values (147±36 vs 150±37 mg/dL, p < 0.001) and were taking fewer medications (median 3 vs 4 drug classes, p < 0.001) than adherent patients. In addition, primary non-adherent patients had lower rates of chronic conditions and less frequent doctor office visits.
Discussion: Within KPSC, an integrated healthcare delivery system, we found that almost 1 in 5 patients were primary non-adherent to their statin medication. Primary non-adherent patients were younger, had fewer chronic conditions and utilized fewer resources. Primary non-adherence to statins may impose heavy burdens on the healthcare system. Targeted interventions to improve primary non-adherence should be undertaken.
- Cardiovascular disease prevention
- Behavioral medicine
- Disease management
- Healthcare delivery systems
- © 2010 by American Heart Association, Inc.