Volume 44 | Number 5p1 | October 2009

Abstract List

Andrew J. Karter Ph.D., Melissa M. Parker M.S., Howard H. Moffet M.P.H., Ameena T. Ahmed, Julie A. Schmittdiel Ph.D., Joe V. Selby


Describe a novel approach to comprehensively summarize medication adherence.

Data Sources/Study Setting

Kaiser Permanente Northern California Diabetes Registry (∼220,000)

Study Design

In a (27,329 subjects prescribed new medications), we used pharmacy utilization data to estimate adherence during 24 months follow‐up. Proportion of time without sufficient medications (medication gaps) was estimated using a novel measure ( [NPMG]) and compared with a traditional measure of adherence.

Data Collection/Extraction Methods

Data derived from electronic medical records and survey responses.

Principal Findings

Twenty‐two percent of patients did not become ongoing users (had zero or only one dispensing of the new prescription). The proportion of newly prescribed patients that never became ongoing users was eightfold greater than the proportion who maintained ongoing use, but with inadequate adherence. Four percent of those with at least two dispensings discontinued therapy during the 24 months follow‐up. NPMG was significantly associated with high out‐of‐pocket costs, self‐reported adherence, and clinical response to therapy.


NPMG is a valid adherence measure. Findings also suggest a larger burden of inadequate adherence than previously thought. Public health efforts have traditionally focused on improving adherence in ongoing users; clearly more attention is needed to address nonpersistence in the very first stages after a new medication is prescribed.