Quality Metric of Measurement for Non-Compliance Rates

Non-compliance is a known issue in the pharmacy world. For example in a study done by Schousboe, Dowd, Davison, & Kane (2010) about non-compliance among patients taking a fracture-prevention medication, only 30%-60% of patients taking this medication were still taking it a year later. This non-compliance can land patients in the hospital with fractures and other injuries. What can we do to prevent these hospitalizations and non-compliance?

The Pharmacy Quality Alliance (PQA) developed a quality metric of measurement for non-compliance rates. This non-compliance is referred to as Primary Medication Non-Adherence (PMN). The Proportion-of-Days Covered (PDC) metric stats are based on claims data that looks at the number of pills a patient has from one fill to the next refill and compares this to the days the patient should actually be on the medication. This has created a rapidly growing force that is creating IT tools to track patient-by-patient non-compliance.

Independent Pharmacies at the Forefront

This metric will be used in our community-based, independent pharmacies first, and is expected to grow to PBM’s. The drawback to this metric is that it can only be calculated after two fills. The patient must fill the RX once, and then come back for a refill. This excludes the “first fill factor”. An example of this is when a patient is prescribed an antibiotic for a bacterial infection, but they do not take the entire amount prescribed. This can result in a relapse for the patient and more treatment.


The PMN metrics are now focusing on certain target medications that treat chronic conditions and they are tracking this information via e-prescriptions. This could result in an increase in incentives of e-prescriptions and other preventive measures that could be taken to avoid non-compliance. There are several proposed interventions and research shows that non-compliance can be reduced by patient education done by pharmacists. “These interventions include an array of medication management services that providers, pharmacies, and payers are increasingly offering to targeted patients.” (Adams, Hubbard, Stolpe, & Cranston, 2015).

Patient education can improve relationships between patients and pharmacy staff, and also reduce hurdles that patient’s face that can cause non-compliance.

References: Primary Medication Non-Adherence Measurements
Adams, A., Hubbard, T., Stolpe, S., & Cranston, L. (2015). The first fill factor: a threat to outcomes, quality, and payment goals. Project HOPE. Retrieved from healthaffairs.org. Schousboe, J., Dowd, B., Davison, M., & Kane, R. (2010). Association of medication attitudes with non-persistence and non-compliance with medication to prevent fractures. Osteoporosis International, 21 (11), 1899-1909. DOI: 10.1007/s00198-009-1141-5.

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Courtney with Shellman Drug Co Pharmacy | Shellman, GA 39886