title: Osteoporosis medication adherence: physician perceptions vs. patients' utilization.
abstract: Few data are available on physician perceptions of osteoporosis medication adherence. This study compared physician-estimated medication adherence with adherence calculated from their patients' pharmacy claims. Women aged ≥45 years, with an osteoporosis-related pharmacy claim between January 1, 2005 and August 31, 2008, and continuous coverage for ≥12 months before and after first (index) claim, were identified from a commercial health plan population. Prescribing physicians treating ≥5 of these patients were invited to complete a survey on their perception of medication adherence and factors affecting adherence in their patients. Pharmacy claims-based medication possession ratio (MPR) was calculated for the 12-month post-index period for each patient. Physicians who overestimated the percentage of adherent (MPR ≥0.8) patients by ≥10 points were considered "optimistic". Logistic regression assessed physician characteristics associated with optimistic perception of adherence. A total of 376 (17.2%) physicians responded to the survey; 62.0% were male, 58.2% were aged 45 to 60 years, 55.3% had ≥20 years of practice, and 35.4% practiced in an academic setting. Participating physicians prescribed osteoporosis medications for 2748 patients with claims data (mean [SD] age of 62.0 [10.6] years). On average, physicians estimated 67.2% of their patients to be adherent; however, only 40% of patients were actually adherent based on pharmacy data. Optimistic physicians (73.4%) estimated 71.9% of patients to be adherent while only 32.2% of their patients were adherent based on claims data. Physicians in academic settings were more likely to be optimistic than community-based physicians (odds ratio 1.69, 95% CI: 1.01, 2.85). Overestimation of medication adherence may impede physicians' ability to provide high quality care for their osteoporosis patients.
authors.affiliation: University of Alabama at Birmingham, FOT 805D, 510 20th Street South, Birmingham, AL 35294, USA. jcurtis@uab.edu
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.forename: Qian
authors.initials: Q
authors.lastname: Cai
authors.forename: Sally W
authors.initials: SW
authors.lastname: Wade
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Stolshek
authors.forename: John L
authors.initials: JL
authors.lastname: Adams
authors.forename: Akhila
authors.initials: A
authors.lastname: Balasubramanian
authors.forename: Hema N
authors.initials: HN
authors.lastname: Viswanathan
authors.forename: Joel D
authors.initials: JD
authors.lastname: Kallich
mesh_terms: D000328:Adult; D000368:Aged; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000453:epidemiology; D010594:Pharmacies / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D016903:Drug Monitoring