Abstract
Background: Primary nonadherence to prescribed medications occurs when patients do not fill or dispense prescriptions written by healthcare providers. Although it has become an important public health issue in recent years, little is known about its frequency, causes, and consequences. Moreover, the pattern of risk factors shows remarkable variability across countries according to the published results. Our study aimed to assess primary nonadherence to medications prescribed by general practitioners (GPs) and its associated factors among adults in Hungary for the period of 2012–2015. Methods: Data on all general medical practices (GMPs) of the country were obtained from the National Health Insurance Fund and the Central Statistical Office. The ratio of the number of dispensed medications to the number of prescriptions written by a GP for adults was used to determine the medication adherence, which was aggregated for GMPs. The effect of GMP characteristics (list size, GP vacancy, patients’ education provided by a GMP, settlement type [urban or rural], and geographical location [by county] of the center) on adherence, standardized for patients’ age, sex, and eligibility for an exemption certificate, were investigated through generalized linear regression modeling. Results: A total of 281,315,386 prescriptions were dispensed out of 438,614,000 written by a GP. Overall, 64.1% of prescriptions were filled. According to the generalized linear regression coefficients, there was a negative association between standardized adherence and urban settlement type (b = -0.099, 95%CI = -0.103 to -0.094), higher level of education (b = -0.440, 95%CI = -0.468 to -0.413), and vacancy of the general practices (b = -0.193, 95%CI = -0.204 to -0.182). The larger GMP size proved to be a risk factor, and there was a significant geographical inequality for counties as well. Conclusions: More than one-third of the written prescriptions of GPs for adults in Hungary were not dispensed. This high level of nonadherence had great variability across GMPs, and can be explained by structural characteristics of GMPs, the socioeconomic status of patients provided, and the quality of cooperation between patients and GPs. Moreover, our findings suggest that the use of the dispensed-to-prescribed medication ratio in routine monitoring of primary health care could effectively support the necessary interventions.
Highlights
The concept of adherence to medication has gained increasing attention (Ho et al, 2009; Lee et al, 2018) and has become an important public health issue (Balkrishnan, 2005; Fischer et al, 2010)
Of the studied General medical practice (GMP), 3.30% were vacant, and 34.70% were in rural areas
Our study demonstrated the adherence-decreasing role of General practitioner (GP) vacancies, when a permanent GP replacing the missing GP provides care
Summary
The concept of adherence to medication has gained increasing attention (Ho et al, 2009; Lee et al, 2018) and has become an important public health issue (Balkrishnan, 2005; Fischer et al, 2010). A meta-analysis of 20 studies conducted between 1998 and 2010 in Australia, Canada, the USA, and Europe to assess the extent of adherence of cardiovascular patients to their regimens indicated that approximately 50% were not properly adherent to cardiovascular medications prescribed for preventive purposes (Naderi et al, 2012). A meta-analysis of hundreds of studies conducted over a 50-year period reported that, on average, approximately one-fourth of the patients did not adhere to their regimens (DiMatteo, 2004). Primary nonadherence to prescribed medications occurs when patients do not fill or dispense prescriptions written by healthcare providers. It has become an important public health issue in recent years, little is known about its frequency, causes, and consequences. Our study aimed to assess primary nonadherence to medications prescribed by general practitioners (GPs) and its associated factors among adults in Hungary for the period of 2012–2015
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