Joan M Neuner1,2,3, Nicole M Fergestrom1,2,3, Purushottam W Laud4,5, Ann B Nattinger1,2,3, Kirsten M M Beyer4,6, Kathryn E Flynn1,7, Liliana E Pezzin1,2,3. 1. Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. 2. Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin. 3. Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. 4. Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin. 5. Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin. 6. Division of Epidemiology, Medical College of Wisconsin, Milwaukee, Wisconsin. 7. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Abstract
BACKGROUND: One-third to one-half of patients prescribed adjuvant endocrine therapy are nonadherent during the recommended 5-year endocrine therapy course. This study investigated whether poor pharmacy synchronization of medication fills (requiring refills on different days) acts as a barrier to adherence. METHODS: A cohort of older women with stage 0 to III endocrine receptor-positive breast cancer in 2011 was identified from the Surveillance, Epidemiology, and End Result-Medicare claims-linked cancer registry. Women with endocrine therapy and at least 1 other medication fill were identified, and the 3-month synchronization of their fills was calculated as 1 minus the quotient of the number of pharmacy visits and the number of filled medications. Regression models were used to examine the association between synchronization (in quartiles adjusted for the number of medications) and adherence to endocrine therapy (defined as a medication possession ratio ≥80%) over the subsequent year. RESULTS: During the 3 months after the first endocrine therapy prescription, the study cohort of 3212 women had a mean of 8.6 pharmacy visits (standard deviation, 4.7) with a mean synchronization of 0.3 (standard deviation, 0.2). Those in the third (odds ratio, 1.29; 95% confidence interval, 1.04-1.59) and fourth (most) medication number-adjusted synchronization quartiles (odds ratio, 1.49; 95% confidence interval, 1.19-1.86) were more likely to be adherent than those in the least. Multivariate model predictions showed that the proportion of patients who were adherent over 1 year varied from 68.9% in the least synchronized quartile to 76.6% in the most synchronized one. CONCLUSIONS: Prescription refill synchronization is strongly associated with adherence to endocrine therapy. Efforts to improve adherence should address this.
BACKGROUND: One-third to one-half of patients prescribed adjuvant endocrine therapy are nonadherent during the recommended 5-year endocrine therapy course. This study investigated whether poor pharmacy synchronization of medication fills (requiring refills on different days) acts as a barrier to adherence. METHODS: A cohort of older women with stage 0 to III endocrine receptor-positive breast cancer in 2011 was identified from the Surveillance, Epidemiology, and End Result-Medicare claims-linked cancer registry. Women with endocrine therapy and at least 1 other medication fill were identified, and the 3-month synchronization of their fills was calculated as 1 minus the quotient of the number of pharmacy visits and the number of filled medications. Regression models were used to examine the association between synchronization (in quartiles adjusted for the number of medications) and adherence to endocrine therapy (defined as a medication possession ratio ≥80%) over the subsequent year. RESULTS: During the 3 months after the first endocrine therapy prescription, the study cohort of 3212 women had a mean of 8.6 pharmacy visits (standard deviation, 4.7) with a mean synchronization of 0.3 (standard deviation, 0.2). Those in the third (odds ratio, 1.29; 95% confidence interval, 1.04-1.59) and fourth (most) medication number-adjusted synchronization quartiles (odds ratio, 1.49; 95% confidence interval, 1.19-1.86) were more likely to be adherent than those in the least. Multivariate model predictions showed that the proportion of patients who were adherent over 1 year varied from 68.9% in the least synchronized quartile to 76.6% in the most synchronized one. CONCLUSIONS: Prescription refill synchronization is strongly associated with adherence to endocrine therapy. Efforts to improve adherence should address this.
Authors: Jessica M Franklin; William H Shrank; Joyce Lii; Alexis K Krumme; Olga S Matlin; Troyen A Brennan; Niteesh K Choudhry Journal: Health Serv Res Date: 2015-04-16 Impact factor: 3.402
Authors: Rachel A Freedman; Ines Vaz-Luis; William T Barry; Huichuan Lii; Nancy U Lin; Eric P Winer; Nancy L Keating Journal: Breast Cancer Res Treat Date: 2014-04-23 Impact factor: 4.872
Authors: Dawn L Hershman; Jennifer Tsui; Jay Meyer; Sherry Glied; Grace Clarke Hillyer; Jason D Wright; Alfred I Neugut Journal: J Natl Cancer Inst Date: 2014-10-27 Impact factor: 13.506
Authors: Jalpa A Doshi; Raymond Lim; Pengxiang Li; Peinie P Young; Victor F Lawnicki; Andrea B Troxel; Kevin G Volpp Journal: Am J Manag Care Date: 2017-02 Impact factor: 2.229
Authors: Alfred I Neugut; Milayna Subar; Elizabeth Ty Wilde; Scott Stratton; Corey H Brouse; Grace Clarke Hillyer; Victor R Grann; Dawn L Hershman Journal: J Clin Oncol Date: 2011-05-23 Impact factor: 44.544
Authors: Caitlin C Murphy; L Kay Bartholomew; Melissa Y Carpentier; Shirley M Bluethmann; Sally W Vernon Journal: Breast Cancer Res Treat Date: 2012-06-12 Impact factor: 4.872
Authors: Zachary A Marcum; Julia Driessen; Carolyn T Thorpe; Walid F Gellad; Julie M Donohue Journal: J Am Geriatr Soc Date: 2014-01-21 Impact factor: 5.562
Authors: Carolyn D Runowicz; Corinne R Leach; N Lynn Henry; Karen S Henry; Heather T Mackey; Rebecca L Cowens-Alvarado; Rachel S Cannady; Mandi L Pratt-Chapman; Stephen B Edge; Linda A Jacobs; Arti Hurria; Lawrence B Marks; Samuel J LaMonte; Ellen Warner; Gary H Lyman; Patricia A Ganz Journal: J Clin Oncol Date: 2015-12-07 Impact factor: 44.544