1. Stay Ahead of the Game of Primary Medication Non-Adherence Measurements
Non-compliance is a known issue in the pharmacy world. For example in a study done by
Schousboe, Dowd, Davison, & Kane (2010) about non-compliance among patients taking
a fracture-prevention medication, only 30%-60% of patients taking this medication were
still taking it a year later. This non-compliance can land patients in the hospital with
fractures and other injuries (Schousboe, Dowd, Davison, & Kane, 2010). What can we do
to prevent these hospitalizations and non-compliance?
The Pharmacy Quality Alliance (PQA) developed a quality metric of measurement for
non-compliance rates. This non-compliance is referred to as Primary Medication Non-
Adherence (PMN). The Proportion-of-Days Covered (PDC) metric stats are based on
claims data that look at the number of pills a patient has from one fill to the next refill
and compares this to the days the patient should actually be on the medication. This has
created a rapidly growing force that is creating IT tools to track patient-by-patient non-
compliance. This metric will be used in our community-based, independent pharmacies
first, and is expected to grow to PBM’s. The drawback to this metric is that it can only be
calculated after two fills. The patient must fill the RX once, and then come back for a
refill. This excludes the “first fill factor”. An example of this is when a patient is
prescribed an antibiotic for a bacterial infection, but they do not take the entire amount
prescribed. This can result in a relapse for the patient and more treatment.

2. The PMN metrics are now focusing on certain target medications that treat chronic
conditions and they are tracking this information via e-prescriptions. This could result in
an increase in the incentivization of e-prescriptions and other preventive measures that
could be taken to avoid non-compliance. There are several proposed interventions and
research shows that non-compliance can be reduced by patient education done by
pharmacists (Adams, Hubbard, Stolpe, & Cranston, 2015). “These interventions include
an array of medication management services that providers, pharmacies, and payers are
increasingly offering to targeted patients.” (Adams, Hubbard, Stolpe, & Cranston, 2015,
pg 1).
Patient education can improve relationships between patients and pharmacy staff and can
reduce hurdles that patients face that can cause non-compliance (Schousboe, Dowd,
Davison, & Kane, 2010).
References:
Adams, A., Hubbard, T., Stolpe, S., & Cranston, L. (2015). The first fill factor: a threat to
outcomes, quality, and payment goals. Project HOPE. Retrieved from healthaffairs.org
Schousboe, J., Dowd, B., Davison, M., & Kane, R. (2010). Association of medication
attitudes with non-persistence and non-compliance with medication to prevent fractures.
Osteoporosis International, 21 (11), 1899-1909. DOI: 10.1007/s00198-009-1141-5.