Original ArticlesTelephoning the patient’s pharmacy to assess adherence with asthma medications by measuring refill rate for prescriptions☆,☆☆
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.
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Cited by (71)
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2023, Paediatric Respiratory ReviewsCaregiver Depressive Symptoms and Primary Medication Nonadherence in Children With Asthma
2022, Journal of Pediatric Health CareCitation Excerpt :It is possible that the children in the sample without pharmacy records had not received a prescription for asthma medications because they had most recently received asthma care in the ED, as opposed to having a regular asthma visit with a primary care provider or specialist who are more likely to prescribe asthma medications. Although pharmacy records have been shown to be reliable compared with other methods such as Medicaid claims data (Mudd et al., 2008) and physician assessment (Sherman, Hutson, Baumstein, & Hendeles, 2000), future research would be strengthened using asthma medication data from multiple sources (i.e., prescribing physician, pharmacy records, and caregiver). Using multiple reporters is especially important considering that aside from pharmacy records, data were based primarily on caregiver self-report which may be limited by recall bias (e.g., a caregiver could have forgotten to identify a pharmacy) and social desirability bias (Shadish, Cook, & Campbell, 2001), particularly given the high rates of caregiver depressive symptoms (Bender & Zhang, 2008).
Severe Asthma in Children
2017, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Objective measures are recommended in the clinical setting because patient self-reports and objective assessments of adherence to ICSs are rarely in agreement.39 Checking prescription refills with the patient's pharmacy40 and checking dosing windows on inhalers is a practical method of identifying such patients. Therapeutic interventions for poor adherence include home-delivery pharmacies, school administration of ICSs, and motivational interviewing and behavioral interventions to improve self-management skills with demonstrated improvements in medication adherence and proper use, knowledge, quality of life, asthma control, lung function, and health care utilization.41-43
Prescription fill patterns in underserved children with asthma receiving subspecialty care
2013, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :If a family did not identify a pharmacy, prescriptions that were actually filled would have been missed and be considered “written but not filled.” However, previous studies, including our prior data, have determined that pharmacy claims data correlate well with Medicaid claims and medical record data in this population.31,36 We could not directly correlate the prescriptions written by the allergy subspecialist vs those written by nonspecialist practitioners because pharmacy records did not include information about the prescribing practitioner.
Risk factors for asthma severity among emergency rooms attendees, Palestine
2009, Pulmonary Pharmacology and TherapeuticsCitation Excerpt :Some studies reported that half of asthma patients fail to adhere to daily treatment regimens either intentionally, unintentionally, or unknowingly [23]. Others showed that poor understanding of medicines' action, fear of steroids side effects, being an adolescence, or from a low socio-economic class such as poverty [12,24], and/or having some factors that reflect a psychological condition such as loss of hope or depression [23], were shown to be important factors that might contribute to low adherence to asthma medicines and thus to asthma severity. In the Palestinian community, poverty, and types of job (58% were house wife and unemployed) and low number of schooling years (77% had less than 9 years) that might represent a low socio-economic class were shown to some extent to play a role in asthma severity (Table 1), as these minorities are usually associated with greater financial barriers [25].
Determining Adherence to Inhaled Corticosteroids From the Epic Electronic Medical Record
2024, Journal of Pediatric Pharmacology and Therapeutics
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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.