Health care education, delivery, and quality
Adherence and persistence with fluticasone propionate/salmeterol combination therapy

https://doi.org/10.1016/j.jaci.2006.07.002Get rights and content

Background

Pharmacy database medication refill studies provide a panoramic view of medication-taking behavior in patients nationally.

Objective

To investigate fluticasone propionate/salmeterol combination (FSC) adherence, including the factors associated with refill adherence in a large national pharmacy database.

Methods

Adherence and persistence were documented for 12 months from date of initial FSC prescription in 5504 patients who filled their medication at a nationwide pharmacy chain.

Results

On average, patients filled enough medication to cover 22.2% of days. More than half the patients filled a 30-day prescription only once over the 1-year interval. Higher adherence levels were associated with being male, being older than 35 years, having a comorbid disorder, a having a copay of $1.01 to $10, previous β2-agonist use, and a prescription for higher-dose FSC.

Conclusion

This pharmacy database study portrays medication adherence levels to be considerably lower than those reported in most clinical trials, suggests that most adults taking FSC obtain a single fill before abandoning their controller medication, and indicates a need for a reappraisal of current treatment guidelines and educational strategies for both providers and patients.

Clinical implications

For many patients, filling of a controller medication is markedly discrepant with practice guidelines. Reappraisal of both the guidelines and strategies to implement them is in order.

Section snippets

Methods

Data in this retrospective cohort study of medication adherence and persistence were obtained from blind computerized pharmacy records of a national pharmacy chain, representing more than 1200 community pharmacies nationwide. Data contained prescription drug activity for all of the prescriptions filled at this national chain for each individual patient regardless of health care plan. Diagnosis information was not included in the database. A total of 5504 patients filled initial FSC prescription

Results

A total of 5504 patients were included in the study. Of these patients, 2349 (42.7%) were prescribed the 200 μg dose, and 3155 (57.3%) were prescribed the 500 μg dose. The distribution of patient demographic characteristics is seen in Table I. Patients' ages ranged from 5 to 96 years (mean ± SD, 54.0 ± 22.0), and 60.2% of the patients were female. Pharmacy databases do not include information on patient race. In this study, race was estimated on the basis of zip codes from US Census data. Of

Discussion

In this study, adult patients on a new prescription for FSC obtained remarkably little of their controller medication. On average, the adherence rate to FSC therapy was only 8.8% over the 1-year period, and the majority of patients filled their prescription only once. The discrepancy between current FSC therapy guidelines and patient behavior is enormous and indicates a need for careful re-evaluation of treatment strategies. Efforts to educate patients and providers about the importance of

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Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

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