New Insights Into Patient And Physician Characteristics That Contribute To Osteoporosis Medication Adherence
Nearly 30 percent of women failed to pick up their bisphosphonate prescriptions, a medication that is most commonly used to treat osteoporosis and similar bone diseases, according to a Kaiser Permanente study published in the journal Osteoporosis International. The failure to pick up these newly prescribed medications, called primary nonadherence, can lead to an increased risk of fractures for these patients.
The study examined the electronic health records of 8,454 women, ages 55 years or older, who were Kaiser Permanente Southern California members between December 2009 and March 2011 and were prescribed a new bisphosphonate medication. It found that 29.5 percent of these women did not pick up their prescription within 60 days of the order date. In particular, older women and those who utilized the emergency department in the prior year were less likely to pick up their bisphosphonate prescription. However, women taking other prescription medications and those who had been hospitalized in the prior year were more likely to pick up their bisphosphonate prescription, according to the researchers.
“Although bisphosphonates have been proven to reduce the risk of osteoporotic fracture, low adherence to these medications is common, which contributes to serious and costly health problems,” said Kristi Reynolds, PhD, MPH, a research scientist at Kaiser Permanente and lead author of the study. “This study simultaneously examined patient and prescribing provider characteristics and helped identify certain factors associated with why patients failed to pick up their new prescriptions.”
Researchers also found that women who received their bisphosphonate prescription from a physician practicing 10 or more years at Kaiser Permanente were more likely to pick up their medication than women who received the prescription from a physician practicing less than 10 years at Kaiser Permanente. In addition, women who received their new bisphosphonate prescription from providers specializing in rheumatology or internal medicine specialties were more likely to pick up the medication than those who received the prescription from providers in other primary care specialties.
Medication nonadherence occurs when a patient does not follow a clinically prescribed medication course, endangering his or her own health and possibly necessitating more aggressive treatment or hospitalizations later. Previous studies estimated that in the United States each year, medication nonadherence contributes to approximately 125,000 deaths and costs the health care system $290 billion. One in three patients prescribed a medication by their health care provider never pick it up from the pharmacy, and, among those who do, nearly 3 in 4 Americans do not take prescription drugs according to providers’ orders.
Osteoporosis is a disease of the skeletal system characterized by low bone mass and deterioration of bone tissue, leading to an increased risk of bone fractures, typically in the wrist, hip and spine. Approximately 10 million Americans have osteoporosis, while about 34 million more are at risk for the disease, according to the National Osteoporosis Foundation. Osteoporosis can occur in both men and women and at any age, but it is most common in older women, according to the National Institutes of Health.
“These findings suggest that health care providers must do a better job of identifying barriers and developing interventions that address the individual patient’s needs and concerns at the time the prescription is ordered,” Reynolds said. “The use of electronic health records, like the system in place at Kaiser Permanente, has helped us better understand and address primary nonadherence, which has historically been difficult to identify.”
Kaiser Permanente can deliver transformational health research in part because it has the largest private electronic health system in the world. The organization’s integrated model and electronic health record system, Kaiser Permanente HealthConnect®, securely connect 9 million people, 533 medical offices and 37 hospitals, linking patients with their health care teams, their personal health information and the latest medical knowledge. It also connects Kaiser Permanente’s epidemiological researchers to one of the most extensive collections of longitudinal medical data available, facilitating studies and important medical discoveries that shape the future of health and care delivery for patients and the medical community.
This study is a part of Kaiser Permanente’s broader efforts to understand and prevent medication nonadherence. Last November, Kaiser Permanente researchers found that patients newly prescribed a cholesterol-lowering medication were more likely to pick it up from the pharmacy if they received automated phone and mail reminders. The study was one of only a few published studies to examine strategies for reducing primary nonadherence. Also last year, a study found that lower copayments and the use of a mail-order pharmacy may reduce racial and ethnic disparities in adherence to hypertension medication.
This study of medication nonadherance and osteoporosis was funded through a contractual agreement between Kaiser Permanente Southern California and Amgen, Inc.
Other authors include: Teresa N. Harrison, SM, and Rong Wei, MA, of the Department of Research & Evaluation, Kaiser Permanente Southern California; Paul Muntner, PhD, MS, of the Department of Epidemiology, University of Alabama Birmingham; T. Craig Cheetham, PharmD, MS, and Southida S. Vansomphone, PharmD, of the Pharmacy Analytical Service, Kaiser Permanente Southern California; Donald E. Morisky, ScD, ScM, MSPH, Department of Community Health Sciences, UCLA Fielding School of Public Health; Stuart Silverman, MD, Department of Medicine, Division of Rheumatology, Cedars-Sinai/UCLA; Deborah T. Gold, PhD, Departments of Psychiatry & Behavioral Sciences, Sociology, and Psychology & Neuroscience, Duke University Medical Center, Durham, NC; and Cynthia D. O’Malley, PhD, Center for Observational Research, Amgen, Inc., Thousand Oaks, Calif.