Featured, In the News / Politics:

A Look at Primary Medication NonAdherence and How it can be Overcome

By:  Erica Dimitropoulos, Assistant Student Editor

Although clinical trials can affirm the efficacy and advantages of all marketed medications, it is obvious that patients cannot benefit from a drug that they choose not to take. Therefore, promoting medication adherence is one of the easiest and most affordable ways to improve treatment outcomes. In order to be successful, adherence regimens necessitate the cooperation and often compromise between healthcare providers and patients. Nonadherence can lead to inadequate control of diseases or conditions, and can create further health problems in the future.1 Also, payers are concerned that nonadherence ultimately raises medical bills; disease progression and complications yield higher costs of care. It is estimated that nonadherence contributes to 125,000 deaths per year and costs our nation approximately $290 billion dollars annually.2

There exist two types of medication nonadherence: primary and secondary. Primary nonadherence occurs when a new prescription is never picked up, whereas secondary nonadherence occurs when a medication is not taken as prescribed.3 Primary nonadherence may happen as a result of a patient’s negative perception of the medication’s necessity and effectiveness, or as a function of the drug’s cost. For example, a patient may not believe that they need to take a blood pressure medication because they do not physically feel the effects of high blood pressure. As a result, they may never pick up their prescription from the pharmacy, or they may deny it due their own cost to benefit ratio. Secondary nonadherence may be a result of the aforementioned concerns as well as a consequence of experiencing unwanted side effects of the medication.3

While many studies have been conducted to explain and minimize secondary nonadherence, few have focused on preventing primary nonadherence from occurring. In 2010, one of the first primary nonadherence studies was conducted at Kaiser Permanente in Southern California. This health care facility had the necessary technology and resources to track the medication behaviors of their patients at local health plan pharmacies. The patients were selected to participate in the study because they had neither filled their new HMG-CoA reductase inhibitor (“statin”) prescription within one to two weeks, nor had they received a different statin within the last year.3

In the study, patients were divided into two groups: those that were to receive reminders and adherence promoters (experimental group), and those who would not (control group). There were 2606 participants in the experimental group and 2610 participants in the control group.3 The goal of the intervention was to provide educational information and encouraging prompts to promote medication adherence.3 The intervention first involved telephone calls that asked patients to retrieve a personalized message. The message was 40 seconds long and began by notifying the patients that they had been prescribed a statin drug for their high cholesterol and that there was no record of this prescription being filled at the associated health plan pharmacies. The message continued to explain the importance of the medication, and provided the phone numbers of the pharmacy and prescribing physician if further information was to be sought. If records indicated that the message was never received, two more attempts were made. Then, if another week passed and no response was seen, participants were mailed a letter of the same nature.

The study proved that the proportion of patients who dispensed their statin medication for the first time was 16.3% greater in the experimental group as compared to the control group. Although the intervention was proven effective in all ages, there was slightly greater efficacy in participants aged 50 and older.3 The experimental group also yielded better results in regards to secondary adherence in the following year (measured by the number of dispensations). A detailed cost analysis was not performed, yet the price of the intervention was estimated at merely $1.70 per person.3 As a result of these findings, Kaiser Permanente in Southern California has recently implemented a new regional outreach program that sends medication reminders to approximately 2,200 members each month.2

From this research, it can be seen that pharmacies that adamantly utilize phone call reminders can greatly reduce primary nonadherence and ultimately avoid adverse health events in the future. Hopefully the evidence that significant results could be obtained by such methods will cause other healthcare facilities to implement similar procedures in the future.


  1. Ho M, Bryson CL, Rumsfeld JS. Medication Adherence: Its Importance in Cardiovascular Outcomes. J Am H Assoc. 2009; 119(23): 3028 – 3035
  2. Medication Adherence Increased By Automated Phone and Mail Notices. Medical News Today. Nov 28, 2012. www.medicalnewstoday.com/releases/253233.php. Accessed Dec 22, 2012.
  3. Derose SF, Green K, Marrett E, et al. Medication Adherence Increased By Automated Phone and Mail Notices. Arch Intern Med. 2012; 1-6. http://archinte.jamanetwork.com. Accessed Dec 22, 2012.
Published by Rho Chi Post
Both comments and trackbacks are currently closed.