A common barrier to taking medications is that patients fail to fill and refill their prescription for a drug. Bruce Bender and his colleagues recently showed the extent of the problem. In the study, they looked at the factors related to refilling prescriptions in a large group of patients. Filling prescriptions was examined for12 months from data of 5,504 asthma patients who filled their medication at a nationwide pharmacy chain. The results showed that, on average, patients filled enough medication to cover 22.2% of the days they were supposed to take the drug. More than half the patients filled a 30-day prescription only once over the 1-year interval. Higher adherence levels were related to being male, being older than 35 years, having more than one chronic disorder, having a lower amount to copay for a drug, previous use of a medication, and a prescription for higher-dose drugs. The conclusion of Bruce and his co-workers was that medication adherence levels were much lower than those reported in most clinical trials, and suggestive of the point that most adults taking controller drug only obtain a single fill of the medication before abandoning the drug.

This was a nice study conducted over one year with a large number of patients. Filling and refilling prescriptions seems to be a huge problem when patients are asked to take a drug to control their chronic illness. We all know what to do if we have an acute illness: we’ll take whatever action we must to get back on track as soon as we can. With a chronic condition, on the other hand, things are not always this clear. The basic question is, “Why should we have to take a drug each day when we don’t see big changes in our health?” This is an excellent question, particularly if the role of the controller drug has never been explained to you as a patient.
The problem of filling and refilling prescriptions is the perfect example of a problem that should be jointly solved by patients and their health care providers. For your part, you must know why each drug you take is required. Always ask questions, particularly if the drug is intended to maintain your health, not to control an acute crisis. Don’t, as has been said before, be afraid to ask questions. Remember there is no such thing as a dumb question.

Do any of you have any comments or suggestions?

Bender BG, Pedan A, & Varasteh LT. Adherence and persistence with fluticasone propionate/salmeterol combination therapy. Joural of Allergy & Clinical Immunology, 2006 118:899-904.