Published Jul 17, 2013

Temple, TX, USA – There are many reasons why patients frequently do not take their medications, but we know relatively little about what affects starting treatment and getting first prescriptions filled. Since this crucial beginning period affects long-term adherence and outcomes, efforts to recognize early problems are important in helping providers quickly address potential barriers. An international team specializing in medication adherence conducted a comprehensive review of the research on initial medication over the past 45 years. Eligible articles were identified from key words, abstracts, and group discussions, and then evaluated for overall quality and carefully examined to discover how initial adherence was defined and analyzed. The study team also summarized the psychosocial and behavioral factors associated with initial adherence problems. Out of almost 900 articles reviewed, only 24 met final inclusion criteria. Factors associated with initial adherence included medication type, patient demographics, illness severity, health beliefs and their provider relationships.  Medication cost or copayments, however, had the greatest impact on initial adherence. Few articles reported health system factors, such as pharmacy information or hospital processes. Lead author, John Zeber, PhD, an investigator from Scott & White Healthcare and the Central Texas VA, summarized the team’s work, stating “Defining initial adherence is complex, but further efforts are essential for recognizing what influences patients at they start treatment. Since interventions have been developed for many adherence barriers, it is crucial that researchers and providers work together to improve adherence and subsequent outcomes.”  The full study, “Systematic Literature Review of Psychosocial and Behavioral Factors Associated with Initial Medication Adherence: A Report of the ISPOR Medication Adherence & Persistence Special Interest Group,” is published in Value in Health.

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