title: Primary non-adherence to bisphosphonates in an integrated healthcare setting.
abstract: We estimated primary non-adherence to oral bisphosphonate medication and examined the factors associated with primary non-adherence. Nearly 30% of women did not pick up their new bisphosphonate within 60 days. Identifying barriers and developing interventions that address patients' needs and concerns at the time a new medication is prescribed are warranted.
  
  
  BACKGROUND
  To estimate primary non-adherence to oral bisphosphonate medications using electronic medical record data in a large, integrated healthcare delivery system and to describe patient and prescribing provider factors associated with primary non-adherence.
  
  
  METHODS
  Women aged 55 years and older enrolled in Kaiser Permanente Southern California (KPSC) with a new prescription for oral bisphosphonates between December 1, 2009 and March 31, 2011 were identified. Primary non-adherence was defined as failure to pick up the new prescription within 60 days of the order date. Multivariable logistic regression models were used to investigate patient factors (demographics, healthcare utilization, and health conditions) and prescribing provider characteristics (demographics, years in practice, and specialty) associated with primary non-adherence.
  
  
  RESULTS
  We identified 8,454 eligible women with a new bisphosphonate order. Among these women, 2,497 (29.5%) did not pick up their bisphosphonate prescription within 60 days of the order date. In multivariable analyses, older age and emergency department utilization were associated with increased odds of primary non-adherence while prescription medication use and hospitalizations were associated with lower odds of primary non-adherence. Prescribing providers practicing 10 or more years had lower odds of primary non-adherent patients compared with providers practicing less than 10 years. Internal medicine and rheumatology providers had lower odds of primary non-adherent patients than primary care providers.
  
  
  CONCLUSIONS
  This study found that nearly one in three women failed to pick up their new bisphosphonate prescription within 60 days. Identifying barriers and developing interventions aimed at reducing the number of primary non-adherent patients to bisphosphonate prescriptions are warranted.
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA 91101, USA. kristi.reynolds@kp.org
authors.forename: K
authors.initials: K
authors.lastname: Reynolds
authors.forename: P
authors.initials: P
authors.lastname: Muntner
authors.forename: T C
authors.initials: TC
authors.lastname: Cheetham
authors.forename: T N
authors.initials: TN
authors.lastname: Harrison
authors.forename: D E
authors.initials: DE
authors.lastname: Morisky
authors.forename: S
authors.initials: S
authors.lastname: Silverman
authors.forename: D T
authors.initials: DT
authors.lastname: Gold
authors.forename: S S
authors.initials: SS
authors.lastname: Vansomphone
authors.forename: R
authors.initials: R
authors.lastname: Wei
authors.forename: C D
authors.initials: CD
authors.lastname: O'Malley
mesh_terms: D000284:Administration, Oral; D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002140:California; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004164:Diphosphonates / Q000008:administration & dosage* / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000517:prevention & control; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016903:Drug Monitoring
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates