Duration of initial antihypertensive prescription and medication adherence: A cohort study among 203,259 newly diagnosed hypertensive patients

Wong, Martin C. S.; Tam, Wilson W.S.; Wang, Haoxiang; Cheung, Clement S; Tong, Ellen L.H.; Cheung, Ngai Tseung; Leeder, Stephen; Griffiths, Siân

doi:10.1016/j.ijcard.2014.12.058

Cited by 17 publications

(18 citation statements)

References 39 publications

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“…• adversely affecting medication adherence and patient satisfaction. [12][13][14] Prescription lengths also vary considerably between, and within, countries. For example, the duration of thyroid prescriptions has been found to range from 28 days in France to 6 months in Australia, 15 and prescription durations across all therapeutic areas in the Canadian province of Quebec were approximately half the length of those in the rest of Canada.…”

Section: Introductionmentioning

confidence: 99%

Impact of issuing longer- versus shorter-duration prescriptions: a systematic review

et al. 2018

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Section: Introductionmentioning

confidence: 99%

Impact of issuing longer- versus shorter-duration prescriptions: a systematic review

et al. 2018

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“…The percentage might even be lower than the value we found because this study was only based on statements given during hospital admission, and sometimes, not even performed by the patients themselves. According to Wong et al, 11 only 32.4% of the hypertensive patients were adherent to the prescribed optimal treatment by the end of the year, while 73% of patients discontinued the medical prescription within 29 days. Other authors confirmed the low adhesion rate to the proposed treatment of chronic diseases and suspect that the adhesion failure rises with increasing age, lower education, insufficient explanation of the treatment by the medical team, and those patients who are not followed-up by a private doctor.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological Profile of Intracerebral Hemorrhage during a 10-Year Period in a Southern Brazilian Region

Almeida

Giacomini

et al. 2018

Arq Bras Neurocir

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Objective Spontaneous intracerebral hemorrhage is responsible for 20% of all cases of cerebrovascular accidents, which might lead to functional disabilities and death. There are few epidemiological data on spontaneous intracerebral hemorrhage in Brazil, and more specifically in the southern region of the country. Methods We reviewed data of 221 patients with intracerebral hemorrhage who attended our department between January of 2004 and December of 2013 and were registered as I61 and I62 according to the 10th edition of the International Classification of Diseases and Related Health Problems (ICD-10). Results From the 221 cases, 53.8% were male, and the median age was 63 years old. Arterial hypertension was reported in 62.4% of the patients. Surgical treatment was performed in 28.9% of all cases and pneumonia affected 19.9%. In 73.4% of the cases, the patients died or were severely disabled at discharge. We found an association of heart disease, coagulopathies, chronic kidney disease, anticoagulant drugs use, surgical treatment, and pneumonia with a poorer outcome. Conclusion The present study describes the epidemiological profile of intracerebral hemorrhage in a southern Brazilian population during a 10-year period.

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“…Shorter prescriptions may (1) increase the costs to the health system through increased GP administrative workload and dispensing fees to pharmacists, 21 (2) increase costs incurred by the patient, 22 (3) have a negative impact on patient satisfaction 23 and (4) have a negative impact on adherence. 24 Whether or not the most commonly used prescription length should be changed was identified as a key area for research in the DH's 2011 roundtable, Making Best Use of Medicines.…”

Section: Guidance and Policy On Repeat Prescription Lengthmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of issuing longer versus shorter duration (3-month vs. 28-day) prescriptions in patients with chronic conditions: systematic review and economic modelling

Miani

Martin

Exley

et al. 2017

Health Technol Assess

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BackgroundTo reduce expenditure on, and wastage of, drugs, some commissioners have encouraged general practitioners to issue shorter prescriptions, typically 28 days in length; however, the evidence base for this recommendation is uncertain.ObjectiveTo evaluate the evidence of the clinical effectiveness and cost-effectiveness of shorter versus longer prescriptions for people with stable chronic conditions treated in primary care.Design/data sourcesThe design of the study comprised three elements. First, a systematic review comparing 28-day prescriptions with longer prescriptions in patients with chronic conditions treated in primary care, evaluating any relevant clinical outcomes, adherence to treatment, costs and cost-effectiveness. Databases searched included MEDLINE (PubMed), EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials. Searches were from database inception to October 2015 (updated search to June 2016 in PubMed). Second, a cost analysis of medication wastage associated with < 60-day and ≥ 60-day prescriptions for five patient cohorts over an 11-year period from the Clinical Practice Research Datalink. Third, a decision model adapting three existing models to predict costs and effects of differing adherence levels associated with 28-day versus 3-month prescriptions in three clinical scenarios.Review methodsIn the systematic review, from 15,257 unique citations, 54 full-text papers were reviewed and 16 studies were included, five of which were abstracts and one of which was an extended conference abstract. None was a randomised controlled trial: 11 were retrospective cohort studies, three were cross-sectional surveys and two were cost studies. No information on health outcomes was available.ResultsAn exploratory meta-analysis based on six retrospective cohort studies suggested that lower adherence was associated with 28-day prescriptions (standardised mean difference –0.45, 95% confidence interval –0.65 to –0.26). The cost analysis showed that a statistically significant increase in medication waste was associated with longer prescription lengths. However, when accounting for dispensing fees and prescriber time, longer prescriptions were found to be cost saving compared with shorter prescriptions. Prescriber time was the largest component of the calculated cost savings to the NHS. The decision modelling suggested that, in all three clinical scenarios, longer prescription lengths were associated with lower costs and higher quality-adjusted life-years.LimitationsThe available evidence was found to be at a moderate to serious risk of bias. All of the studies were conducted in the USA, which was a cause for concern in terms of generalisability to the UK. No evidence of the direct impact of prescription length on health outcomes was found. The cost study could investigate prescriptions issued only; it could not assess patient adherence to those prescriptions. Additionally, the cost study was based on products issued only and did not account for underlying patient diagnoses. A lack of good-quality evidence affected our decision modelling strategy.ConclusionsAlthough the quality of the evidence was poor, this study found that longer prescriptions may be less costly overall, and may be associated with better adherence than 28-day prescriptions in patients with chronic conditions being treated in primary care.Future workThere is a need to more reliably evaluate the impact of differing prescription lengths on adherence, on patient health outcomes and on total costs to the NHS. The priority should be to identify patients with particular conditions or characteristics who should receive shorter or longer prescriptions. To determine the need for any further research, an expected value of perfect information analysis should be performed.Study registrationThis study is registered as PROSPERO CRD42015027042.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Duration of initial antihypertensive prescription and medication adherence: A cohort study among 203,259 newly diagnosed hypertensive patients

Cited by 17 publications

References 39 publications

Impact of issuing longer- versus shorter-duration prescriptions: a systematic review

Impact of issuing longer- versus shorter-duration prescriptions: a systematic review

Epidemiological Profile of Intracerebral Hemorrhage during a 10-Year Period in a Southern Brazilian Region

Clinical effectiveness and cost-effectiveness of issuing longer versus shorter duration (3-month vs. 28-day) prescriptions in patients with chronic conditions: systematic review and economic modelling

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