Prescription Compliance of medications for diabetes, hypertension, cardiovascular diseases, and hyperlipidemia in Taiwan

Diabetes, hypertension, cardiovascular diseases (CVD) and hyperlipidemia are leading causes of death worldwide. Non-compliance of medication for these chronic conditions could lead to compromised health benefits and serious economic consequences in terms of wasted time and money. In Taiwan, over 99% of the population is now covered by the National Health Insurance (NHI) program, which was launched in 1995. However, over the past decade, due to the program's comprehensive benefits, freedom in choosing providers, and low co-payment, the number of annual physician visit is high and outpatient care accounts for about 2/3 of the total expenditure. In order to contain the soaring outpatient expenditure, the NHI provides incentives (waiving the co-payment for drug fees) to encourage patients with chronic diseases to take a refillable prescription that can be refilled after 30 days at any NHI-contracted pharmacies.

Using a one-million random sample of the 22-million NHI enrollees, provided by the National Health Research Institute, we investigated their compliance of the refillable prescriptions among their outpatient claims for diabetes, hypertension, CVD, and hyperlipidemia. All prescriptions with the International Classification of Diseases (ICD) codes related to these conditions were identified and the compliance of prescriptions was determined by how many of these refillable prescriptions were actually refilled after the first 30 days.

Preliminary results show that non-compliance of prescriptions of these chronic conditions is a significant problem, especially for prescriptions issued at the primary care clinics. For example, in 2006, 66.3% of the diabetic prescriptions from two well-known medical centers were refilled after 30 days. But, only 14.9% of the diabetic prescriptions from primary care clinics got refilled after 30 days. Similar situations were seen for hypertension, CVD, and hyperlipidemia prescriptions over the study period.

These findings indicate that patients who visited a primary care clinic were more likely to shop for another doctor so that a majority of the medications prescribed by primary care doctors were not followed through. On the other hand, it is equally likely that physicians at larger medical facilities (e.g. medical centers) might have some incentives to prescribe more refillable prescriptions in order to ease their burden in outpatient services. Good compliance should have a positive effect on clinical outcomes and a more efficient way of disease management. It is suggested that measures should be taken to improve patient compliance.