Adherence to previously prescribed pharmacotherapy in patients undergoing planned inpatient treatment: first results of the PRIMULA study

Aim. To assess adherence to previously prescribed pharmacotherapy among patients with chronic noncommunicable diseases admitted for elective inpatient treatment at a federal medical research center.

Material and methods. PRIMULA is a cross-sectional observational study conducted at the National Medical Research Center for Therapy and Preventive Medicine from February 19, 2025 to February 19, 2026. The study included patients admitted to the emergency departmentwho agreed to complete the adherence questionnaire of the National Society of Evidence-Based Pharmacotherapy (NSEBP) and signed informed consent for personal data processing. The questionnaire consisted of 3 modules and required 5-7 minutes to complete. This article presents a preliminary analysis of the data collected during the first 6 months of the study.

Results. Among 3,006 patients, men accounted for 53.6%; the median age was 65 [55;72] years. A total of 1,690 (56.2%) patients were married, 453 (15.1%) were smokers, 724 (24.1%) had a disability, and 1,119 (37.2%) were employed. Before hospitalisation, 849 (28.2%) patients had not been followed up in healthcare institutions, 1,318 (43.8%) had been followed up at their local outpatient clinic, 38 (1.3%) at a research clinic, and 801 (26.7%) at other medical institutions of various profiles (p<0.001). Data sufficient to determine adherence level were available for 2,654 of 3,006 patients. Of these, 2,227 (83.9%) were adherent to therapy, 273 (10.3%) were partially adherent, and 154 (5.8%) were fully non-adherent; 352 patients (11.7%) had incomplete questionnaire data. Overall, impaired adherence was identified in 427 patients (16.1%), corresponding to approximately one in six patients with available data. The most significant reasons for complete non-adherence were adverse effects during therapy, lack of treatment effect, polypharmacy, and doubts about the need for the prescribed treatment; for partial nonadherence, the main reasons were taking a large number of medications, fear of adverse effects, unwillingness to take the prescribed therapy, and forgetfulness. During repeat hospitalisation, impaired adherence was identified in 20 patients, representing 13.1% of those with available repeat questionnaire data (n=153). Analysis of the data obtained made it possible to identify an additional type of non-adherence to therapy, namely hidden non-adherence (n=11).

Conclusion. Impaired adherence to previously prescribed pharmacotherapy is a clinically significant problem already at the stage of elective hospitalization. The brief NSEBP questionnaire may be used as a screening tool to identify overt adherence problems and signs of hidden non-adherence. The findings support the need for systematic assessment of adherence both in the outpatient setting and at hospital admission.

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