Individuals with multiple comorbid medical conditions, or multimorbidity, must perform numerous self-care activities, including the management of multiple prescription medications. Though such medications have proven efficacious in large clinical studies, in the real world their therapeutic effectiveness is subject to the complexities of prescribing, obtaining, and taking medications appropriately. In this issue of the Archives, Choudhry and colleagues report the association of therapeutic complexity with patient adherence to 2 cardiovascular medications purchased through a national pharmacy benefits manager. The authors assessed complexity based on the number of medications, prescribers, pharmacies, pharmacy visits, and proportion of medications filled per pharmacy visit (ie, refill consolidation). Adherence to a statin or ACEI/ARB was ascertained during a 1-year period by calculating the percentage of time the medication was available based on refill records.
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