Determinants of primary nonadherence to medications prescribed by general practitioners among adults in Hungary: Cross-sectional evaluation of health insurance data

Nouh Harsha, László Ko Rösi, Anita Pálinkás, Klára Bíró, Klára Boruzs, Róza Ádány, János Sándor, Árpád Czifra

Research output: Article

Abstract

Background: Primary nonadherence to prescribed medications occurs when patients do not fill or dispense prescriptions written by healthcare providers. Although it has become an important public health issue in recent years, little is known about its frequency, causes, and consequences. Moreover, the pattern of risk factors shows remarkable variability across countries according to the published results. Our study aimed to assess primary nonadherence to medications prescribed by general practitioners (GPs) and its associated factors among adults in Hungary for the period of 2012–2015. Methods: Data on all general medical practices (GMPs) of the country were obtained from the National Health Insurance Fund and the Central Statistical Office. The ratio of the number of dispensed medications to the number of prescriptions written by a GP for adults was used to determine the medication adherence, which was aggregated for GMPs. The effect of GMP characteristics (list size, GP vacancy, patients’ education provided by a GMP, settlement type [urban or rural], and geographical location [by county] of the center) on adherence, standardized for patients’ age, sex, and eligibility for an exemption certificate, were investigated through generalized linear regression modeling. Results: A total of 281,315,386 prescriptions were dispensed out of 438,614,000 written by a GP. Overall, 64.1% of prescriptions were filled. According to the generalized linear regression coefficients, there was a negative association between standardized adherence and urban settlement type (b = ‑0.099, 95%CI = ‑0.103 to ‑0.094), higher level of education (b = ‑0.440, 95%CI = ‑0.468 to ‑0.413), and vacancy of the general practices (b = ‑0.193, 95%CI = ‑0.204 to ‑0.182). The larger GMP size proved to be a risk factor, and there was a significant geographical inequality for counties as well. Conclusions: More than one‑third of the written prescriptions of GPs for adults in Hungary were not dispensed. This high level of nonadherence had great variability across GMPs, and can be explained by structural characteristics of GMPs, the socioeconomic status of patients provided, and the quality of cooperation between patients and GPs. Moreover, our findings suggest that the use of the dispensed‑to‑prescribed medication ratio in routine monitoring of primary health care could effectively support the necessary interventions.

Original languageEnglish
Article number1280
JournalFrontiers in Pharmacology
Volume10
Issue numberOCT
DOIs
Publication statusPublished - jan. 1 2019

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Medication Adherence
Hungary
Health Insurance
General Practice
General Practitioners
Prescriptions
Patient Compliance
Linear Models
National Health Programs
Patient Education
Social Class
Health Personnel
Primary Health Care
Public Health
Education

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Determinants of primary nonadherence to medications prescribed by general practitioners among adults in Hungary : Cross-sectional evaluation of health insurance data. / Harsha, Nouh; Ko Rösi, László; Pálinkás, Anita; Bíró, Klára; Boruzs, Klára; Ádány, Róza; Sándor, János; Czifra, Árpád.

In: Frontiers in Pharmacology, Vol. 10, No. OCT, 1280, 01.01.2019.

Research output: Article

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abstract = "Background: Primary nonadherence to prescribed medications occurs when patients do not fill or dispense prescriptions written by healthcare providers. Although it has become an important public health issue in recent years, little is known about its frequency, causes, and consequences. Moreover, the pattern of risk factors shows remarkable variability across countries according to the published results. Our study aimed to assess primary nonadherence to medications prescribed by general practitioners (GPs) and its associated factors among adults in Hungary for the period of 2012–2015. Methods: Data on all general medical practices (GMPs) of the country were obtained from the National Health Insurance Fund and the Central Statistical Office. The ratio of the number of dispensed medications to the number of prescriptions written by a GP for adults was used to determine the medication adherence, which was aggregated for GMPs. The effect of GMP characteristics (list size, GP vacancy, patients’ education provided by a GMP, settlement type [urban or rural], and geographical location [by county] of the center) on adherence, standardized for patients’ age, sex, and eligibility for an exemption certificate, were investigated through generalized linear regression modeling. Results: A total of 281,315,386 prescriptions were dispensed out of 438,614,000 written by a GP. Overall, 64.1{\%} of prescriptions were filled. According to the generalized linear regression coefficients, there was a negative association between standardized adherence and urban settlement type (b = ‑0.099, 95{\%}CI = ‑0.103 to ‑0.094), higher level of education (b = ‑0.440, 95{\%}CI = ‑0.468 to ‑0.413), and vacancy of the general practices (b = ‑0.193, 95{\%}CI = ‑0.204 to ‑0.182). The larger GMP size proved to be a risk factor, and there was a significant geographical inequality for counties as well. Conclusions: More than one‑third of the written prescriptions of GPs for adults in Hungary were not dispensed. This high level of nonadherence had great variability across GMPs, and can be explained by structural characteristics of GMPs, the socioeconomic status of patients provided, and the quality of cooperation between patients and GPs. Moreover, our findings suggest that the use of the dispensed‑to‑prescribed medication ratio in routine monitoring of primary health care could effectively support the necessary interventions.",
keywords = "Dispensed prescriptions, Exemption certificate, Geographical inequality, GMP size, GP vacancy, Level of education, Medication adherence, Urbanization",
author = "Nouh Harsha and {Ko R{\"o}si}, L{\'a}szl{\'o} and Anita P{\'a}link{\'a}s and Kl{\'a}ra B{\'i}r{\'o} and Kl{\'a}ra Boruzs and R{\'o}za {\'A}d{\'a}ny and J{\'a}nos S{\'a}ndor and {\'A}rp{\'a}d Czifra",
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AU - Harsha, Nouh

AU - Ko Rösi, László

AU - Pálinkás, Anita

AU - Bíró, Klára

AU - Boruzs, Klára

AU - Ádány, Róza

AU - Sándor, János

AU - Czifra, Árpád

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N2 - Background: Primary nonadherence to prescribed medications occurs when patients do not fill or dispense prescriptions written by healthcare providers. Although it has become an important public health issue in recent years, little is known about its frequency, causes, and consequences. Moreover, the pattern of risk factors shows remarkable variability across countries according to the published results. Our study aimed to assess primary nonadherence to medications prescribed by general practitioners (GPs) and its associated factors among adults in Hungary for the period of 2012–2015. Methods: Data on all general medical practices (GMPs) of the country were obtained from the National Health Insurance Fund and the Central Statistical Office. The ratio of the number of dispensed medications to the number of prescriptions written by a GP for adults was used to determine the medication adherence, which was aggregated for GMPs. The effect of GMP characteristics (list size, GP vacancy, patients’ education provided by a GMP, settlement type [urban or rural], and geographical location [by county] of the center) on adherence, standardized for patients’ age, sex, and eligibility for an exemption certificate, were investigated through generalized linear regression modeling. Results: A total of 281,315,386 prescriptions were dispensed out of 438,614,000 written by a GP. Overall, 64.1% of prescriptions were filled. According to the generalized linear regression coefficients, there was a negative association between standardized adherence and urban settlement type (b = ‑0.099, 95%CI = ‑0.103 to ‑0.094), higher level of education (b = ‑0.440, 95%CI = ‑0.468 to ‑0.413), and vacancy of the general practices (b = ‑0.193, 95%CI = ‑0.204 to ‑0.182). The larger GMP size proved to be a risk factor, and there was a significant geographical inequality for counties as well. Conclusions: More than one‑third of the written prescriptions of GPs for adults in Hungary were not dispensed. This high level of nonadherence had great variability across GMPs, and can be explained by structural characteristics of GMPs, the socioeconomic status of patients provided, and the quality of cooperation between patients and GPs. Moreover, our findings suggest that the use of the dispensed‑to‑prescribed medication ratio in routine monitoring of primary health care could effectively support the necessary interventions.

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KW - Dispensed prescriptions

KW - Exemption certificate

KW - Geographical inequality

KW - GMP size

KW - GP vacancy

KW - Level of education

KW - Medication adherence

KW - Urbanization

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