Drug Initiation: Major Issue In Long-Term Adherence To Medication Therapy

Gentofte, Denmark – Poor adherence to long-term medication therapy among patients with a chronic disease is well-known, but the nature of poor adherence over time, at a population level is not well established. Studies from clinical trials have shown that discontinuation is the main problem. However, everyday life differs from the structured context of a clinical trial with support around initiation and continuous follow-up.

In the study, “A Multi-State Model and an Algorithm for Measuring Long-Term Adherence to Medication: A Case of Diabetes Mellitus Type 2,” researchers from Steno Diabetes Center and the Universities of Copenhagen and Southern Denmark used a new method to obtain high quality information on patient adherence behaviour over time.

The objective of the study was to equip health care providers with high quality data on long-term adherence to medication to improve resource allocation and to help patients to have better adherence and thus better health outcomes.

By linking two electronic registers – medical doctors’ prescriptions of Metformin and Simvastatin [to patients at Steno Diabetes Center] with type 2 diabetes; and a Danish nationwide register with registrations of medicine picked up by patients – it was possible to map patterns of adherence to medication therapy.

Looking at adherence to medication over time, the study showed that those patients who wait to initiate treatment present a bigger problem than patients who do not implement a treatment dosing regimen well or who discontinue treatment early. (Adherence to medication therapy stabilized approximately one year after the prescription of medication.)

According to lead author of the study, Majken Linnemann Jensen, MSc, PhD fellow, from Steno Diabetes Center and University of Copenhagen, “Discontinuation is the main driver of poor adherence to medication therapy in clinical trials. This study shows that, in a real-life setting, we need to focus more on the lack of initiation to improve adherence to medication therapy in the treatment of type 2 diabetes. This could easily be the case in other disease areas as well and should be further investigated.”

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