Question 4: What proportion of prescriptions are unfilled or not picked up by patients?
Millions of new prescriptions are written each year, but for a variety of reasons a substantial proportion are never dispensed, or not picked up by, or on behalf of, the patient. This is known as primary nonadherence (i.e. not filling a first prescription for a drug). Knowing the volume and type of prescriptions that fall in this category would inform medication management practice and policy.
Two entries were received for this question, one from Manitoba and one from Quebec. Together their analyses included over 200,000 prescriptions.
In their entry for this question, the Manitoba Primary Care Research Network (MaPCReN) used data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). In their answer, the MOXXI-McGill team from McGill University used data from the Medical Office of the XXIst Century (MOXXI) community-based electronic health record that linked with prescription information from the Quebec health insurance agency (RAMQ).
The analysis will identify the proportion of new (first-fill) prescriptions that are dispensed and picked up by the patient within 30 and 90 days. Refills should be excluded.
The analysis should be reported in the following fashion:
• Total number of new prescriptions written
• Proportion of new prescriptions that make it to the pharmacy for dispensing
• Proportion of new prescriptions that are picked up by patients
Supplementary analysis by class of medications and/or by reason for the prescription (e.g. on-going management of a chronic condition) would add value.
Numerator: The analysis should include the number of prescriptions written by community-based health care providers counted in the denominator that are not dispensed within 30 (90) days, as well as the number of prescriptions written by community-based health care providers counted in the denominator that are not picked up by, or on behalf of, the patient within 30 (90) days.
Denominator: Total number of prescriptions written by community-based health care providers during a given time period.
Sample: Ideal sample size of 50,000 or more prescriptions. Note: veterinary prescriptions should be excluded.
Timeframe: The time frame covered by the denominator should be at least one year, to avoid any potential seasonal effects. The analysis should include an observation period of at least 90 days after the last prescription in the denominator was written.
Manitoba Primary Care Research Network
Team bio: Manitoba Primary Care Research Network (MaPCReN), the University of Manitoba’s affiliate of the Canadian Primary Care Research Network (CPCSSN)
Team bio: We are a group of researchers from the McGill Clinical and Health Informatics (MCHI) group specializing in the use of e-technologies to improve the safety and quality of health care.