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 (e‑prescriptions) 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 e‑prescriptions 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 e‑prescriptions 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 e‑prescriptions 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. E‑prescriptions allow the identification and analysis of drivers of this phenomenon. Our findings may help designing national health and medicine policies.