Telephoning the patient's pharmacy to assess adherence with asthma medications by measuring refill rate for prescriptions

Objective: To determine whether a prescription refill history obtained by t elephoning patients' pharmacies identifies poor adherence with asthma medic ations more frequently than physician assessment. Methods: The study population consisted of 116 children with persistent ast hma who were Medicaid recipients; patients who received medication samples were excluded. During a clinic visit pulmonologists interviewed patients, c aretakers, or both and estimated adherence on a checklist. A nurse asked th e caretakers where they obtained medications and telephoned 66 identified p harmacies for refill histories, The maximum possible adherence was calculat ed as the number of doses refilled/number of doses prescribed x 100 for a m ean duration of 163 days (range, 63 to 365 days). The accuracy of the refil l information was determined from Medicaid reimbursement records. Results: Information provided Ly pharmacies was 92% accurate. The mean (95% CI) of maximum potential adherence was 72% (65%,77%) for theophylline, 61% (55%,68%) for inhaled corticosteroids, and 38%, (23%,53%) for cromolyn; on ly cromolyn and theophylline were significantly different. Physicians were able to identify 21 (49%) of 13 patients who refilled less than or equal to 50% of prescribed doses of long-term In symptom controllers and only 3 (27 %) of 11 patients who used albuterol excessively. Conclusions: Physicians often were unable to identify patients with very po or adherence. Checking prescription refills is an accurate and practical me thod of identifying such patients.