SCOTTSDALE, ARIZ. – Dermatology patients who received new electronic prescriptions were significantly more likely to fill them than patients given paper prescriptions at a major urban hospital, a study showed.
This is the largest study to directly measure primary nonadherence to dermatologic medications, said Dr. Adewole Adamson of the department of dermatology, University of North Carolina at Chapel Hill. The results belie at least one past study linking e-prescriptions with lower fill rates, he said at the annual meeting of the Society for Investigative Dermatology.
Relatively few large studies have examined adherence to dermatology prescriptions. Furthermore, most looked only at claims data and assessed refill rates, not primary adherence, Dr. Adamson said. “Even fewer studies have focused on e-prescriptions, compared with paper prescriptions, which is astounding, as that is the direction in which we are heading,” he added.
What literature does exist also points to concerns, Dr. Adamson noted, referring to a study in Denmark, which found that half of psoriasis patients never filled their prescriptions (J Am Acad Dermatol. 2008 Jul;59[1]:27-33). Another study found that 27% of patients with acne did not fill all their prescriptions for the disease, he added (JAMA Dermatol. 2015;151[6]:623-6).
For this study, Dr. Adamson and his colleagues retrospectively studied medical charts for 2,579 dermatology outpatients at Parkland Hospital in Dallas between 2011 and 2013. Nearly half the patients were Hispanic, two-thirds were women, and the average age was 48 years. Among these 2,579 patients, 851 received e-prescriptions, and 1,728 received paper prescriptions. Patients received more than 4,600 new dermatology prescriptions – about 1.8 per patient. They could fill these at the hospital or at one of several outlying pharmacies.
The overall rate of complete primary adherence was 59%, while 13% of patients filled only some prescriptions. Thus, almost 28% of patients were completely nonadherent, similar to the findings of previous studies, Dr. Adamson said.
Notably, the rate of primary adherence was 16% higher among patients who received e-prescriptions: Of those who received e-prescriptions, 70% filled all their prescriptions, while another 11% filled some of them. In contrast, only 54% of patients filled all their paper prescriptions (P less than .001), while 14% filled some of them.
For prescriptions overall (written and e-prescriptions), patients aged 60-69 years had the highest fill rate (69%), while patients younger than 30 had the lowest (46%). Sex did not affect fill rates, but native Spanish speakers were somewhat more likely to fill all their prescriptions (62%) than native English speakers (57%).
The more prescriptions patients received, the less likely they were to fill them all. For example, about 60% of patients given one or two prescriptions filled all of them, while only 35% of patients given five prescriptions did so. That finding underscores the importance of simplifying medication regimens, Dr. Adamson said. “In terms of e-prescriptions, the horse is already out of the barn. I don’t think we are going to go back to paper prescriptions. But at least in this population, the data shows that electronic prescribing helps with compliance,” he added.
The study was supported by the University of North Carolina at Chapel Hill and the University of Texas Southwestern Medical Center. Dr. Adamson had no relevant financial disclosures.