Collectively, our data on PDSCC, DFSP, MAC, and EMPD, combined with other studies in the literature, show that MMS is the most effective therapy for these rare aggressive cutaneous malignancies.

BACKGROUND:Little is known about first-fill adherence rates for diabetic medications and factors associated with non-fill.OBJECTIVE: To assess the proportion of patients who fill their initial prescription for a diabetes medication, understand characteristics associated with prescription first-fill rates, and examine the effect of first-fill rates on subsequent A1c levels. DESIGN:Retrospective, cohort study linking electronic health records and pharmacy claims. PARTICIPANTS:One thousand one hundred thirty-two patients over the age of 18 who sought care from the Geisinger Clinic, had Geisinger Health Plan pharmacy benefits, and were prescribed a diabetes medication for the first time between 2002 and 2006. MEASUREMENTS:The primary outcome of interest was naïve prescription filled by the patient within 30 days of the prescription order date. RESULTS:The overall first-fill adherence rate for antidiabetic drugs was 85%. Copays < $10 (OR 2.22, 95% CI 1.57-3.14) and baseline A1c > 9% (OR 2.63, 95% CI 1.35, 5.09) were associated with improved firstfill rates while sex, age, and co-morbidity score had no association. A1c levels decreased among both filling and non-filling patients though significantly greater reductions were observed among filling patients. Biguanides and sulfonylureas had higher first-fill rates than second-line oral agents or insulin.CONCLUSIONS: First-fill rates for diabetes medication have room for improvement. Several factors that predict non-filling are readily identifiable and should be considered as possible targets for interventions.

BACKGROUND Between the promise of evidence-based medicine and the reality of inadequate patient outcomes lies patient adherence. Studies of prescription adherence have been hampered by methodologic problems. Most rely on patient self-report of adherence or cross-sectional data of plan-wide prescription fills to estimate patient-level adherence. METHODS We conducted a retrospective cohort study and linked individual patient data for incident prescriptions for antihypertensive medications from electronic health records (EHRs) to claims data obtained from the patient's insurance plan. Clinical data were obtained from the Geisinger Clinic, a 41 site group practice serving central and northeastern Pennsylvania with an EHR in use since 2001. Adherence was defined as a prescription claim generated for the first-fill prescription within 30 days of the prescribing date. RESULTS Of the 3,240 patients written a new, first-time prescription for an antihypertensive medication, 2,685 (83%) generated a corresponding claim within 30 days. Sex, age, therapeutic class, number of other medications prescribed within 10 days of the antihypertensive prescription, number of refills, co-pay, comorbidity score, baseline blood pressure (BP), and change in BP were significantly associated with first-fill rates (P < 0.05). CONCLUSIONS Patients who are older, female, have multiple comorbidities, and/or have relatively lower BPs may be less likely to fill a first prescription for antihypertensive medications and may be potential candidates for interventions to improve adherence to first-fill prescriptions.

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