title: Evaluating the Impact of Sample Medication on Subsequent Patient Adherence.
abstract: BACKGROUND
  Medication nonadherence is problematic throughout health care practice. Patient nonadherence is a result of several factors, such as financial issues, confusion about the medication, or concerns about possible side effects. Efforts to improve adherence have been implemented, but new strategies are needed to ensure that patients fill their medication prescriptions and adhere to their prescribed use.
  
  
  OBJECTIVE
  To investigate whether providing patients with a free 30-day supply of medication at the point of care via a dispensing kiosk-a secure, computerized cabinet placed in the prescriber's office-that provides sample medication and educational materials had a measurable impact on adherence and health care cost.
  
  
  METHODS
  The study sample consisted of patients drawn from the electronic health records of a large health care provider who were prescribed medications to treat diabetes, hypertension, and dyslipidemia. The comparison groups included a treatment group of patients who each received a 30-day generic sample of medication and a control group of patients who did not receive a sample. The study outcome was primary medication non-adherence (PMN), defined as whether a patient filled a prescription within 90, 180, or 365 days of prescribing. Only patients receiving a prescription for the first time were considered; patients on a medication before receipt of the sample were dropped. Postprescription medication adherence (PPMA), measured as proportion of days covered (PDC) and proportion of days covered ≥ 80% (PDC80), was also examined. Propensity score methods and multivariate regression models were used to examine the outcomes and group differences. Costs to the patient before and after the prescription were also analyzed. Key informant interviews were conducted with physicians, and qualitative analyses were performed.
  
  
  RESULTS
  Patients who received a 30-day generic medication sample had a higher probability of filling a first prescription within 90 days (72.2% for treatment patients vs. 37.6% for controls, P < 0.001); 180 days (79.1% vs. 43.3%, respectively, P < 0.001); and 365 days (85.5% vs. 48.6%, P < 0.001). The medication sample had a positive effect on PDC for 90 days, with treatment patients having 72.8% adherent days versus 35.1% adherent days for controls (average treatment effect [ATE] = 37.5%, P < 0.001). At 180 days, PDC adherence was 57.1% for treatment patients versus 35.4% for controls (ATE = 21.5%, P < 0.001), and 43.6% versus 33.9%, respectively (ATE = 9.5%, P < 0.001) for the 365-day period. PDC80 was significantly better among treatment patients at 90 days (53.5% vs. 31.2%, respectively, ATE = 22.4%, P < 0.001) and 180 days (38.4% vs. 29.1%, ATE = 9.2%, P < 0.001), but not at 365 days (23.7% vs. 23.7%, ATE = -0.02, not significant). Costs were reduced by $395 for the treatment group. Interviews with clinicians indicated a positive view of the program.
  
  
  CONCLUSIONS
  Providing a free sample medication improved the probability of patients filling their initial prescriptions and adhering to those medications. This program can affect health care costs, as evidenced by lower costs for the treatment group.
  
  
  BACKGROUND
  Financial support for this study was provided by MedVantx. UMPC Health Plan reviewed and commented on the manuscript. Hogue is an employee of MedVantx and also reviewed the manuscript. Manolis is employed by UPMC Health Plan. The remaining authors report no other conflicts of interest. Study concept and design were contributed by Pringle. Aldridge took the lead in data collection, along with Kearney. Data interpretation was performed primarily by Radack, along with Kearney and Grasso. The manuscript was written by Kearney, Aldridge, and Radack and revised by Kearney, Manolis, Hogue, and Radack.
authors: 1 Program Evaluation and Research Unit, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania.
authors: Janice L
authors: JL
authors: Pringle
authors: 2 RTI International, Research Triangle Park, North Carolina.
authors: Arnie
authors: A
authors: Aldridge
authors: 1 Program Evaluation and Research Unit, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania.
authors: Shannon M
authors: SM
authors: Kearney
authors: 1 Program Evaluation and Research Unit, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania.
authors: Kim
authors: K
authors: Grasso
authors: 1 Program Evaluation and Research Unit, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania.
authors: John
authors: J
authors: Radack
authors: 3 Managed Care and Clinical Services, MedVantx, San Diego, California.
authors: Susan
authors: S
authors: Hogue
authors: 4 UPMC Health Plan, Pittsburgh, Pennsylvania.
authors: Chronis
authors: C
authors: Manolis
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000191:economics*; D016568:Drugs, Generic / Q000191:economics* / Q000600:supply & distribution*; D057286:Electronic Health Records / Q000639:trends; D005260:Female; D005102:Health Expenditures / Q000639:trends; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D016568:Drugs, Generic