Primary Non-Adherence to Antihistamines-Conclusions From E-Prescription Pilot Data in Poland.

BACKGROUND: In allergic conditions such as allergic rhinitis and urticaria, orally administered H1-antihistamines belong to first-line therapy and therefore, are widely prescribed. Due to the frequent, and often chronic, course of allergic diseases, adherence is of great importance. In 2018 a novel, nationwide e-prescription system was piloted in Poland, which allowed to analyze primary non-adherence to orally administered H1 antihistamines. OBJECTIVES: To assess the primary non-adherence to orally administered H1-antihistamines in Poland, defined as not redeeming the drug issued on a particular e-prescription within its validity period. METHODS: The study was based on all e-prescriptions issued in Poland in 2018, issued for 119.880 drugs. The analysis included nine major orally administered H1 antihistamines available in Poland. RESULTS: Out of 2280 analyzed e-prescriptions on orally administered antihistamines, 1803 (79.1%) of them were redeemed. Therefore, the level of primary non-adherence reached 21%. Among women it reached 19.9%, but it was not significantly lower than among men (23.4%, p=0.064). The highest non-adherence (31.3%) was observed in the age group 19-39, whilst the highest adherence rate (84.6%) was observed in those 75 years or older. The most frequently prescribed second-generation antihistamine was bilastine-596 e-prescriptions with 23.7% primary non-adherence. CONCLUSIONS: More than 1 out of 5 e-prescriptions on orally administered H1-antihistamines were not redeemed in Poland in 2018. Age, but not gender, significantly influenced the degree of primary non-adherence to these drugs. To authors knowledge, this is the first real-life study on primary non-adherence to H1-antihistamines in Poland and one of the very few on this subject worldwide.

Primary nonadherence to medication and its drivers in Poland: findings from the electronic prescription pilot analysis.

INTRODUCTION: Primary nonadherence to medication occurs when a patient does not fill a prescription and often leads to suboptimal patient outcomes, lost productivity, and increased net costs. Pilot introduction of electronic prescriptions (e­prescriptions) in Poland took place in 2018, enabling nationwide assessment of primary nonadherence. OBJECTIVES: To determine the prevalence and drivers of primary nonadherence in Poland. METHODS: This retrospective analysis included data from all e­prescriptions issued in Poland in 2018. Primary nonadherence was defined as not filling a prescription within 1 month from the date of issuing. RESULTS: Out of all 119 880 e­prescriptions issued in Poland in 2018, 94 913 were filled, thus the primary nonadherence rate reached 20.8%. Although no differences in primary nonadherence were observed between sexes, age was found to have a significant effect, with older groups showing lower rates of primary nonadherence. In addition, slightly lower rates of primary nonadherence (17.0%) were found for e­prescriptions issued for selected drugs of key importance (n = 47 492). Multivariable analysis performed within this subset showed that those aged ≥75 years had the lowest odds for nonadherence (odds ratio, 0.55; 95% CI, 0.48-0.64). Differences in primary nonadherence rates were observed across therapeutic areas (lowest value in antibiotics, 14.3%), drug classes (lowest value in sulfonylureas, 13.2%), and individual drugs. Primary nonadherence rates were lower for drugs covered by the "Leki 75+" program, which makes them free of charge for those aged 75 years or older. CONCLUSIONS: A high percentage of prescriptions issued in Poland are never filled. E­prescriptions allow the identification and analysis of drivers of this phenomenon. Our findings may help designing national health and medicine policies.