Prescription-level factors associated with primary nonadherence to dermatologic medications

Abstract

Purpose: To analyze factors associated with primary nonadherence to dermatologic medications and study whether prescription-level factors are associated with primary nonadherence.

Materials and methods: A retrospective review of medical records of new dermatology patients from January 2011 to December 2013 at a single urban safety-net hospital outpatient dermatology clinic with a closed pharmacy system.

Results: A total of 4307 prescriptions were written for 2490 patients. The overall primary nonadherence rate was 24.7%. The most prescribed medication classes in order of frequency were topical corticosteroids, topical antibiotics, topical retinoids, oral antibiotics, and topical antifungals. After multivariable adjustment for patient, provider, and prescription characteristics, when compared to topical corticosteroids, topical antibiotics, oral antifungals, and oral antivirals were less likely to be filled (RR 0.9 [95% CI, 0.84–0.95]), (RR 0.69 [95% CI, 0.59–0.81]), and (RR 0.65 [95% CI, 0.46–0.93]), respectively. Conversely, topical vitamin D analogs, oral immunomodulators, and oral retinoids were more likely to be filled (RR 1.15 [95% CI, 1.02–1.28]), (RR 1.11 [95% CI, 1.04–1.19]), and (RR 1.15 [95% CI, 1.04–1.27]), respectively.

Conclusions: Medication class or administration route may be associated with increased risk of nonadherence, and identifying these factors is important in considering ways to reduce primary nonadherence rates in dermatology.

Keywords:

• Primary nonadherence
• adherence
• medication class
• pharmacy

Acknowledgement

We are indebted to Dr. Bhavin Patel, informatics pharmacist in the Parkland Memorial Hospital Pharmacy Department, for assistance with data acquisition. He was not paid for this work.

Disclosure statement

The authors whose names are listed above certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Additional information

Funding

University of Texas Southwestern Medical Center10.13039/100007914

UNC School of Medicine10.13039/100011082This study was supported in part by the Department of Dermatology at the University of Texas Southwestern Medical Center and the UNC School of Medicine. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Parkland Memorial Hospital Pharmacy Department, for assistance with data acquisition. He was not paid for this work.