Original Articles
Telephoning the patient’s pharmacy to assess adherence with asthma medications by measuring refill rate for prescriptions,☆☆

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Abstract

Objective: To determine whether a prescription refill history obtained by telephoning patients’ pharmacies identifies poor adherence with asthma medications more frequently than physician assessment. Methods: The study population consisted of 116 children with persistent asthma who were Medicaid recipients; patients who received medication samples were excluded. During a clinic visit pulmonologists interviewed patients, caretakers, or both and estimated adherence on a checklist. A nurse asked the caretakers where they obtained medications and telephoned 66 identified pharmacies for refill histories. The maximum possible adherence was calculated as the number of doses refilled/number of doses prescribed × 100 for a mean duration of 163 days (range, 63 to 365 days). The accuracy of the refill information was determined from Medicaid reimbursement records. Results: Information provided by pharmacies was 92% accurate. The mean (95% CI) of maximum potential adherence was 72% (65%,77%) for theophylline, 61% (55%,68%) for inhaled corticosteroids, and 38% (23%,53%) for cromolyn; only cromolyn and theophylline were significantly different. Physicians were able to identify 21 (49%) of 43 patients who refilled ≤50% of prescribed doses of long-term symptom controllers and only 3 (27%) of 11 patients who used albuterol excessively. Conclusions: Physicians often were unable to identify patients with very poor adherence. Checking prescription refills is an accurate and practical method of identifying such patients. (J Pediatr 2000;136:532-6)

Section snippets

Patients

The patients in the study were Medicaid recipients with persistent asthma who were under the care of the Pediatric Pulmonary Division at the University of Florida. Patients returning for follow-up visits who were taking slow-release theophylline, an inhaled corticosteroid, or nebulized cromolyn were eligible for inclusion in the study if they had not been seen for at least 2 months. They were identified before clinics by chart review. At the time of this study, none of the patients were taking

RESULTS

Physician assessment and pharmacy refill data were collected for controller medications for 116 patients (76 boys) and for albuterol use in 82. The mean age ± SD of the patients was 7.8 ± 4.6 years. The prescription refill observation period ranged from 63 to 365 days (mean ± SD, 163 ± 65 days). Based on Medicaid reimbursement records, the information provided by pharmacies was accurate for 92% of the prescription refills (r = 0.9, P =.0001). The remaining 8% consisted of refills that were

DISCUSSION

In this study actual medication-taking behavior was not measured; prescription refills served as a surrogate for adherence and represented the upper limit, that is, the maximum possible adherence. We included only patients who denied receiving free medication samples, and the refill observation period averaged 163 days, so it is unlikely that our patients were taking medication left over from previous prescriptions or from any source other than a prescription refill. Therefore this method can

Acknowledgements

The authors thank Patty Flewelling, RN, for collecting most of the data, Anthony Salerno for assisting Ms Flewelling, Gerry Wells, RPh, and Jane Mann of the Florida Medicaid Program for providing pharmacy reimbursement records for each patient, and Kathy Rice for word processing. Douglas Theriaque assisted Dr Hutson in the statistical analysis.

References (14)

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Dr Sherman is supported in part by a Pediatric Pulmonary Center Grant (MCJ-129162-06-0), from the Maternal and Child Health Bureau, DHHS, and Dr Hutson is supported in part by National Institutes of Health General Clinical research grant M01 RR00082.

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Reprint requests: James Sherman, MD, University of Florida, Health Science Center (Box 100296), Gainesville, FL 32610-0296.

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