POSB240 The Effects of COVID-19 Infection on Medication Adherence with Chronic Therapies in Italy: The Fail-to-Refill Project

ABSTRACT

Objectives: The study aimed to design and develop a monitoring system to assess the possible implications of the COVID-19 infection and the measures taken to limit its spreading on adherence to chronic therapies. Methods: Within the HEALTH-DB project and in collaboration with a pool of Local Healthcare Entities, a monitoring system called "fail-to-refill" was designed to evaluate the lack of adherence to chronic therapies in Italian clinical practice settings. Based on the date and dosage coverage of last prescription, all patients that should have refilled in the last month a prescription for chronic therapies are identified, and it is verified if they had the refill. The analysis was centred on two classes of chronic treatments, belonging to different distribution systems lipid-lowering agents (distributed in community pharmacy) and biological therapies for chronic autoimmune conditions (dispensed by National Health System hospitals for outpatients use, ie direct distribution). The monthly analysis covered the no-COVID-19 period (01/2017-02/2020) and the COVID-19 period (03/2020-12/2020). Results: During the COVID-19 period, in May 2020, an increase (42%) of the fail-to-refill rate for lipid-lowering agents distributed in community pharmacies was observed, compared to the rate during the no-COVID-19 period (34% -35% during 2017-2019), while negligible changes were observed in the following months. Regarding the direct distribution, the fail-to-refill rate of biologics was higher during the COVID-19 period, 34% (May), 35% (June), and 37% (July) versus 26-30% (May 2017-2019), 28-29% (June 2017-2021), and 24-28% (July 2017-2019) of the no-COVID-19 period. Conclusions: During the COVID-19 pandemic, an increasing trend of failed refill to chronic therapies has been observed, especially among biologics, probably due to their dispensing system and the difficulty of accessing hospitals. The "fail-to-refill" monitoring system could support the Health Authorities to identify patients who do not correctly refill their prescriptions, thus optimizing the medication adherence and reducing negative clinical outcomes related to it.