RT Journal
A1 Choudhry NK, Fischer MA, Shrank WH
T1 INfluence of therapeutic complexity on medication adherence in the netherlands—reply
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2011
FD May 9
VO 171
IS 9
SP 864
OP 865
DO 10.1001/archinternmed.2011.176
UL http://dx.doi.org/10.1001/archinternmed.2011.176
AB 
Geers et al applied our measures of therapeutic complexity to statin adherence in the Dutch health care system and found less strong correlations between complexity and adherence than we recently reported.1 Their analysis highlights the importance of context in evaluating research results. Like all studies, our findings are primarily generalizable to settings similar to that of the population evaluated. The US health care system is unique in the extent to which coverage and care are fragmented: patients may receive coverage from private or public sources; drug coverage is often “carved out” and administered separately from medical benefits; patients can receive care from numerous different physicians or other health care providers; and prescriptions may be written by multiple prescribers and filled at many pharmacies on numerous visits. We evaluated this last set of factors and found them to be strongly associated with nonadherence. In contrast, Geers and colleagues' analysis based on a health care system with very little complexity for patients to receive and fill prescriptions found the influence of these factors to be smaller. Rather than contradictory, the results of Geers et al amplify the importance of complexity and the potential role of a “pharmacy home” in the US health care system.