Implications of COVID-19 Infection on Medication Adherence with Chronic Therapies in Italy: A Proposed Observational Investigation by the Fail-to-Refill Project

Abstract

Poor medication adherence leads to worsening of clinical outcomes and increases healthcare costs, especially in the context of chronic conditions. The effects of new COVID-19 infection and the measures taken in response to the outbreak are further increasing the concerns about medication adherence. Patients with chronic diseases, many of whom are older adults, have been strongly recommended to stay at home and avoid social contacts even with family members, who often provide support for regular use of therapies. Moreover, the mobilization of health personnel to the frontline of the COVID-19 infection could limit access to healthcare services. Within the Health-DB project, the Fail-To-Refill monitoring system was designed to evaluate the lack of adherence to chronic therapies in Italian clinical practice settings. Considering the date and dose coverage of last prescription, all patients due to refill this prescription for a chronic therapy in the last month were identified, and it was verified if they had the refill. The proposed future analysis, based on the data linkage between the current administrative flows of the Italian Local Health Units involved, will be carried out on a monthly basis from the beginning of the infection, and the “post-Covid-19” results will be compared with “pre-COVID-19” results, calculated for the last three years for patients with chronic therapies. Preliminary data herein presented showed a trend of increased failed refill during the months of lockdown for lipid-lowering and biologic therapies. The pre-COVID-19 trend compared to that of post-COVID-19 in the next months will be useful to estimate the percentage of failure to refill truly related to COVID-19 and on the measures adopted. The identification of patients that do not refill their prescriptions allows healthcare professionals to put in place actions aimed to promptly correct the lack of adherence, thus reducing the associated negative outcomes.

Keywords:

• chronic disease
• real-world data
• SARS-CoV-2
• treatment adherence

Acknowledgments

An extract of this paper was published in Italian on “Sole 24 ore” newspaper. Alessandro Ghigi (acknowledged for his contribution to the methodology and to the collection and analysis of the data reported). Network Health-db: Domenica Daniela Ancona (ASL Barletta-Andria-Trani), Margherita Andretta (Azienda Zero Regione del Veneto), Antonella Barbieri (ASL Vercelli), Fausto Bartolini (USL Umbria 2), Simona Bettoni (USL della Valle d’Aosta), Clara Bianchi (ASL Frosinone), Luigi Carlo Bottaro (ASL 3 Genovese), Giacomino Brancati (Regione Calabria), Arturo Cavaliere (ASL Viterbo), Marta Caltabellotta (ASL 3 Genovese), Sabrina Crescenzi (ASL Frosinone), Adele De Francesco (Regione Calabria), Stefania Dell’Orco (ASL Roma 6), Fulvio Ferrante (ASL Frosinone), Stefano Grego (ASL 3 Genovese), Alessandra Ladecola (ASL Frosinone), Marisa Latini ASL Roma 5), Renato Lombardi (ASL Foggia), Lorella Lombardozzi (Regione Lazio), Jacopo Luboz (USL della Valle d’Aosta), Marco Mattei (ASL Roma 6), Alessandra Mecozzi (ASL Latina), Eduardo Nava (ASL Napoli 3 Sud), Romina Pagliaro (ASL Roma 5), Alessandra Puteo (ASL Foggia), Giuseppe Quintavalle (ASL Roma 4), Lorenzo Sampietro (ASL 3 Genovese), Chiara Serpieri (ASL Vercelli), Loredana Ubertazzo (ASL Roma 4), Patrizia Venditti (ASL Frosinone), Adriano Vercellone (ASL Napoli 3).

Disclosure

The authors report no conflicts of interest in this work.