ArticleThe Annals of pharmacotherapy2011
Importance of including early nonadherence in estimations of medication adherence.
Article in The Annals of pharmacotherapy, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
25 citing papers in PubMed, 3 syntheses or guidelines pooled it, 50 citations in OpenAlex.
- Initial non-adherence to lipid-lowering medication: a systematic literature review.BMC primary care · 2024Pooled it
- Initial non-adherence to antihypertensive medications in the United States: a systematic literature review.Journal of human hypertension · 2022Pooled it
- Reasons for Primary Medication Nonadherence: A Systematic Review and Metric Analysis.Journal of managed care & specialty pharmacy · 2018Pooled it
- A randomized telephone intervention trial to reduce primary medication nonadherence.Journal of managed care & specialty pharmacy · 2015Trial
- Primary adherence to medications for the treatment of major depressive disorder: A descriptive study using real-world data.Journal of managed care & specialty pharmacy · 2026Article
- Artificial intelligence approaches to predicting treatment non-adherence in chronic diseases: a narrative review.Frontiers in digital health · 2026Review
- The Impact of the Multidisciplinary Team on Medication Adherence in Type 2 Diabetes: A Narrative Review.Journal of multidisciplinary healthcare · 2026Review
- Suitability of Measures of Pharmacy-Based Medication Adherence for Routine Clinical Use Among Patients with Chronic Diseases: A Systematic Review.Patient preference and adherence · 2025Review
- Initial medication adherence in newly diagnosed glaucoma patients: three adherence measures.International journal of ophthalmology · 2023Article
- Diabetes medication regimens and patient clinical characteristics in the national patient-centered clinical research network, PCORnet.Pharmacology research & perspectives · 2020Article
- Initiation and Single Dispensing in Cardiovascular and Insulin Medications: Prevalence and Explanatory Factors.International journal of environmental research and public health · 2020Article
- Primary Nonadherence to Oral Anticoagulants in Patients with Atrial Fibrillation: Real-World Data from a Population-Based Cohort.Journal of managed care & specialty pharmacy · 2018Article
- Primary non-adherence and the new-user design.Pharmacoepidemiology and drug safety · 2018Article
- Predicting Adherence and Persistence with Oral Bisphosphonate Therapy in an Integrated Health Care Delivery System.Journal of managed care & specialty pharmacy · 2017Article
- Article
- Primary Nonadherence, Associated Clinical Outcomes, and Health Care Resource Use Among Patients with Rheumatoid Arthritis Prescribed Treatment with Injectable Biologic Disease-Modifying Antirheumatic Drugs.Journal of managed care & specialty pharmacy · 2016Article
- Medication Adherence Does Not Explain Black-White Differences in Cardiometabolic Risk Factor Control among Insured Patients with Diabetes.Journal of general internal medicine · 2016Article
- Medicare Star excludes diabetes patients with poor CVD risk factor control.The American journal of managed care · 2014Article
- Primary non-adherence in general practice: a Danish register study.European journal of clinical pharmacology · 2014Article
- Providing patients with pharmacogenetic test results affects adherence to statin therapy: results of the Additional KIF6 Risk Offers Better Adherence to Statins (AKROBATS) trial.The pharmacogenomics journal · 2014Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundMany medication adherence metrics are based on refill rates determined from pharmacy claims databases. However, these methods do not incorporate assessment of nonadherence to new prescriptions when those prescriptions are never dispensed (primary nonadherence), or dispensed only once (early nonpersistence). As a result, published studies may overestimate adherence, but the extent of overestimation posed by not considering patients with primary nonadherence and early nonpersistence has not been assessed.
objectiveTo estimate the magnitude of misestimation in adherence estimates that results from not including patients with primary nonadherence and early nonpersistence.
methodsWe conducted a retrospective cohort study of 15,417 patients enrolled in an integrated health care delivery system who were newly prescribed an antihypertensive, antidiabetic, or antihyperlipidemic medication. We linked prescription orders to medication dispensings. Based on dispensing and refill rates, we stratified patients into primary nonadherent, early nonpersistent, and ongoing dispensings groups. Adherence was estimated using the proportion of days covered (PDC). Standardized observation periods were applied across all groups.
resultsA total of 1142 (7.4%) patients were primarily nonadherent, 3356 (21.8%) demonstrated early nonpersistence, and 10,919 (70.8%) patients received ongoing dispensings, with a mean PDC of 84%. Not including primarily nonadherent and early nonpersistent patients in calculations resulted in adherence estimates overestimated by 9-18%.
conclusionsWhen medication adherence is estimated from pharmacy claims databases, adherence estimates are substantially inflated because primarily nonadherent and early nonpersistent patients are not included in the estimations. An implication of this incorrect estimation is potential distortion of the true relationship between medication adherence and clinical outcomes.
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