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Medical Care Research and Review, Vol. 63, No. 4, 427-446 (2006)
DOI: 10.1177/1077558706288845
© 2006 SAGE Publications

Patient-Reported Underuse of Prescription Medications: A Comparison of Nine Surveys

Duane M. Kirking

University of Michigan College of Pharmacy Center for Medication Use, Policy, and Economics

James A. Lee

Altarum Institute

Jeffrey J. Ellis

University of Michigan College of Pharmacy Center for Medication Use, Policy, and Economics

Becky Briesacher

University of Massachusetts Medical School Division of Geriatrics

Patrick L. Mckercher

University of Maryland School of Pharmacy Center for Drugs and Public Policy

Nine national surveys documenting patient underuse of prescription medications were examined to describe the variation and trends in that underuse and identify possible reasons for the substantially different rates that were reported. Underuse includes unfilled prescriptions, delayed therapy, reduced frequency, and lowered dosage. Rates of cost-related patient underuse in the studies ranged from 1.6 to 22 percent. Insurance coverage, level of wealth, age, and health status were the sociodemographic variables most strongly related to underuse. Seven additional factors in the design and administration of the surveys were identified as providing plausible explanations for the variance across surveys. The most conspicuous variation was between three government-sponsored periodic surveys and six generally one-time assessments, with the latter yielding higher rates and greater variance in underuse. Understanding the factors contributing to the variation in reported rates of underuse of medications is an important prerequisite for the design of effective prescription-drug benefit programs.

Key Words: underused prescriptions • medication use • health behavior surveys • nonprocurement


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