title: New prescription medication gaps: a comprehensive measure of adherence to new prescriptions.
abstract: OBJECTIVE
  Describe a novel approach to comprehensively summarize medication adherence.
  
  
  METHODS
  Kaiser Permanente Northern California Diabetes Registry (n approximately 220,000)
  
  
  METHODS
  In a new prescription cohort design (27,329 subjects prescribed new medications), we used pharmacy utilization data to estimate adherence during 24 months follow-up. Proportion of time without sufficient medications (medication gaps) was estimated using a novel measure (New Prescription Medication Gaps [NPMG]) and compared with a traditional measure of adherence.
  
  
  METHODS
  Data derived from electronic medical records and survey responses.
  
  
  RESULTS
  Twenty-two percent of patients did not become ongoing users (had zero or only one dispensing of the new prescription). The proportion of newly prescribed patients that never became ongoing users was eightfold greater than the proportion who maintained ongoing use, but with inadequate adherence. Four percent of those with at least two dispensings discontinued therapy during the 24 months follow-up. NPMG was significantly associated with high out-of-pocket costs, self-reported adherence, and clinical response to therapy.
  
  
  CONCLUSIONS
  NPMG is a valid adherence measure. Findings also suggest a larger burden of inadequate adherence than previously thought. Public health efforts have traditionally focused on improving adherence in ongoing users; clearly more attention is needed to address nonpersistence in the very first stages after a new medication is prescribed.
authors.affiliation: Kaiser Permanente, Oakland, CA 94612, USA. andy.j.karter@kp.org
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Parker
authors.forename: Howard H
authors.initials: HH
authors.lastname: Moffet
authors.forename: Ameena T
authors.initials: AT
authors.lastname: Ahmed
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
authors.forename: Joe V
authors.initials: JV
authors.lastname: Selby
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000628:therapy*; D015331:Cohort Studies; D003669:Deductibles and Coinsurance / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006302:Health Services Research / Q000458:organization & administration; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000628:therapy; D006973:Hypertension / Q000175:diagnosis / Q000628:therapy; D007345:Insurance Claim Review; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D014481:United States; D016903:Drug Monitoring