Repeat prescriptions: refill adherence in relation to patient and prescriber characteristics, reimbursement level and type of medication

Background: Repeat prescribing used in long-term pharmacotherapy is often associated with inadequate patient medication, including non-adherence. In this paper we explore patients' drug refill adherence with repeat prescriptions and relate refill data to patient age and gender, type of prescriber, type of prescribed drug, and reimbursement level. Methods: During one week of 2002, copies of 3636 repeat prescriptions filled at 16 large Swedish pharmacies were collected. Satisfactory refill adherence was defined as dispensed refills covering 80-120% of the prescribed treatment time. Under- and oversupplying were defined as < 80% and > 120% coverage, respectively. Result: The average level of refill adherence was 57%, and the level of under- and oversupplying 21% and 22%, respectively. There was no gender difference. Patients who were exempt from payment had higher oversupplies than others (33% versus 19%), and patients of general practitioners had higher refill adherence than patients of hospital physicians. The highest refill adherence was observed for contraceptives (81%) and the lowest for anti-asthmatics, proton pump inhibitors and non-steroidal anti-inflammatory drugs (30-40%). Conclusions: Refill non-adherence includes both under- and oversupplying and may vary due to different attitudes between prescribers and between patients. Different therapeutic indications and reimbursement systems are other apparent causes. These observations should be considered in programs aiming to assist patients in following medication prescriptions.