What makes it more likely for new prescriptions to be filled?

Recently, some colleagues and I at NYU looked at factors influencing first-fill adherence to new asthma prescriptions. Lower copay and oral administration were associated with greater first fill. See the abstract below and the full paper here.

Lower Copay and Oral Administration: Predictors of First-Fill Adherence to New Asthma Prescriptions

Background: Nonadherence to asthma medications is associated with increased emergency department visits and hospitalizations. If adherence is to be improved, first-fill adherence is thefirst goal to meet after the physician and patient have decided to begin treatment. Little is known about first-fill adherence with asthma medications and the factors for no-fill.

Objective: The goal of the study was to examine the proportion of patients who fill a new prescription for an asthma medication and analyze characteristics associated with this first-fill.

Methods: This retrospective cohort study linked electronic health records with pharmacy claims. The cohort was comprised of 2023 patients aged 18 years or older who sought care from the Geisinger Clinic, had Geisinger Health Plan pharmacy benefits, and were prescribed an asthma medication for the first time between 2002 and 2006. The primary outcome of interest was first-time prescription filled by the patient within 30 days of the prescription order date. Covariates examined included factors related to the patient (ie, age, sex, and ethnicity), comorbidities and utilization (ie, Charlson comorbidity index, number of office visits, number of additional medications), asthma treatment (ie, delivery route, pharmacologic class), and pharmacy co-pay amount. A logistic-regression model was used to determine covariates associated with first-fill.

Results: The overall first-fill rate for new asthma medications was 78%. First-fill rate was lower for patients with a copay above the mean of $12 (odds ratio = 0.76; 95% confidence interval, 0.58-0.99) and higher for patients prescribed oral plus inhaled medications (versus inhaled only, odds ratio = 3.91; 95% confidence interval, 2.15-7.11).

Conclusions: Several factors associated with failing to fill an initial prescription for asthma can be addressed through simple interventions: screening for difficulties a patient may have in filling prescriptions, avoiding nonformulary medications, and recognizing the barrier that high copays present. In addition, for employers and policymakers, decreasing copay may improve adherence and, therefore, asthma control.

Is medicine a Jewish profession?: quote from a talk in preparation

if it is legitimate at all to say that medicine is a Jewish profession, it is not because that medicine is "more Jewish" than it is Christian/Hindu/African-American/etc. (that would be ridiculous) but because the ethical characteristics of the physician, while universally appreciated and able to be implemented in any culture, conform well with Jewish self-understanding, i.e. that Jews should be bayshanim (humble), rakhmonim (merciful) and goymlei khasodim (performers of deeds of lovingkindness).

Department of Welcome Exaggeration, Melbourne Edition

THE JEWISH CULTURAL CENTER AND NATIONAL LIBRARY KADIMAH

has the pleasure of presenting one of the world's most interesting
and well known lecturers visiting from the United States

DR. ZACHARY SHOLEM BERGER

two lectures will take place in the Leo Fink Hall at the "Kadimah"
7 Selwyn Street Elsternwick at 3 pm. on the following dates

"IS MEDICINE A JEWISH PROFESSION?"
12 July 2009 - lecture .n English

"WHY IS MEDICINE A JEWISH PROFESSION?"

26 July 2009 - lecture in Yiddish

Refreshments will be served.

Smoothing Over

problems pave
the potholes
with blacker
asphalt, so the
problems make
a swift
double bump
Not gone
Not gone

Ten Things I Know About Bellevue Hospital That Will Never Come in Handy Again

1. The closets that are always open across from the chemistry lab have signs that say "THESE DOORS MUST NOT BE LEFT OPEN."

2. Cocaine for sale!

3. There is only so much Valium in the hospital, and in a night with a lot of alcohol withdrawers, Bellevue just might run out. Then - the apocalypse. Or some other benzodiazepine, whatever.

4. What happens on the eighteenth floor, stays on the eighteenth floor.

5. During my intern year I got sick of people mistaking Bellevue, New York's oldest public hospital, for a psychiatric institution. Now I know the truth: Bellevue is a psychiatric institution which just happens to have a lot of medical beds too.

6. Sure you don't need to call an inpatient dermatology consult very often, but when you do, are they ever wrong?

7. No, the patient doesn't speak (Spanish, Chinese) - they're just (Filipino, Indonesian).

8. [insulting comment about a subspecialty or particular nursing station]

9. Sure you put the order in. You have to call too.

10. Now call again.

Evidence-Based Lobbying

Leaders of the medical-industrial complex wonder if the Dartmouth research findings might be a touch overblown. I dunno - maybe. But don't we doctors do a lot else based on much less evidence? What fraction of hallowed medical practice is based on no more than class IIb recommendations?

Heck, I'm ready for New York to get less medical money. I don't think the kinds of places I'd rather practice are the ones that are overspending.

Super Jewish Historical Prediction Game: Female Modern Orthodox Clergy Edition

I. circa 1980

Cathy Conservative: Women can be rabbis!
Joe Modern Orthodox: Pshaw!

II. 2009

Joe Modern Orthodox: Women can...umm...kinda be rabbis!

III. 2025

Joe M.O.: ___________ (fill in the blank)