title: Impact of prescription size on statin adherence and cholesterol levels.
abstract: BACKGROUND
  Therapy with 3-Hydroxy-3-methylglutaryl Co-enzyme A reductase inhibitors (statins) improve outcomes in a broad spectrum of patients with hyperlipidemia. However, effective therapy requires ongoing medication adherence; restrictive pharmacy policies may represent a barrier to successful adherence, particularly among vulnerable patients. In this study we sought to assess the relationship between the quantity of statin dispensed by the pharmacy with patient adherence and total cholesterol.
  
  
  METHODS
  We analyzed a cohort of 3,386 patients receiving more than one fill of statin medications through an integrated, inner-city health care system between January 1, 2000 and December 31, 2002. Our measure of adherence was days of drug acquisition divided by days in the study for each patient, with adequate adherence defined as > or = 80%. Log-binomial regression was used to determine the relative risk of various factors, including prescription size, on adherence. We also assessed the relationship between adherence and total cholesterol using multiple linear regression.
  
  
  RESULTS
  After controlling for age, gender, race, co-payment, comorbidities, and insurance status, patients who obtained a majority of fills as 60-day supply compared with 30-day supply were more likely to be adherent to their statin medications (RR 1.41, 95% CI 1.28-1.55, P < 0.01). We found that statin non-adherence less than 80% was predictive of higher total serum cholesterol by 17.23 +/- 1.64 mg/dL (0.45 +/- 0.04 mmol/L).
  
  
  CONCLUSIONS
  In a healthcare system serving predominantly indigent patients, the provision of a greater quantity of statin medication at each prescription fill contributes to improved adherence and greater drug effectiveness.
authors.affiliation: General Internal Medicine, Denver Health and Hospital Authority, 777 Bannock St,, Box 0148, Denver, CO 80204, USA. Holly.Batal@dhha.org
authors.forename: Holly A
authors.initials: HA
authors.lastname: Batal
authors.forename: Mori J
authors.initials: MJ
authors.lastname: Krantz
authors.forename: Rita A
authors.initials: RA
authors.lastname: Dale
authors.forename: Phillip S
authors.initials: PS
authors.lastname: Mehler
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
mesh_terms: D000367:Age Factors; D000368:Aged; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003120:Colorado; D019033:Delivery of Health Care, Integrated; D011307:Drug Prescriptions / Q000191:economics*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000188:drug therapy* / Q000191:economics; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010593:Pharmaceutical Services / Q000191:economics / Q000458:organization & administration*; D012646:Self Administration / Q000191:economics; D012959:Socioeconomic Factors; D013997:Time Factors; D035862:Vulnerable Populations
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol