Measurement of Adherence in Pharmacy Administrative Databases: A Proposal for Standard Definitions and Preferred Measures

Hess, Lisa M.; Raebel, Marsha A.; Conner, Douglas A.; Malone, Daniel C.

doi:10.1345/aph.1h018

Cited by 654 publications

(630 citation statements)

References 25 publications

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“…Type 2 diabetes patients were identified based on the presence of any International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes 250.0x through 250.9x (where x = 0 or 2) on outpatient, inpatient, or professional claims, and/or having any oral hypoglycemic claims. 18 An index date was defined as the date of a patient's first prescription fill for oral hypoglycemics between July 1, 2007, and December 31,2009, with no antidiabetes prescriptions in the prior 6 months (i.e., new users). We followed each patient's refill claims for 12 months following the index date.…”

Section: Study Design and Cohortmentioning

confidence: 99%

“…We constructed two adherence measures in the first year of oral hypoglycemic treatment: 1) a traditional measure using average annual PDC, [30][31][32] , and 2) the trajectory of adherence defined by monthly PDC with oral hypoglycemics over the first year. Group-based trajectory models account for both the timing and extent of non-adherence and can therefore identify more heterogeneity in non-adherence behavior than traditional single measures.…”

Section: Outcome Measuresmentioning

confidence: 99%

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Trajectories of Diabetes Medication Adherence and Hospitalization Risk: A Retrospective Cohort Study in a Large State Medicaid Program

et al. 2016

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BACKGROUND: Numerous interventions are available to boost medication adherence, but the targeting of these interventions often relies on crude measures of poor adherence. Group-based trajectory models identify individuals with similar longitudinal prescription filling patterns. Identifying distinct adherence trajectories may be more useful for targeting interventions, although the association between adherence trajectories and clinical outcomes is unknown. OBJECTIVE: To examine the association between adherence trajectories for oral hypoglycemics and subsequent hospitalizations among diabetes patients. DESIGN: Retrospective cohort study. PATIENTS: A total of 16,256 Pennsylvania Medicaid enrollees, non-dually eligible for Medicare, initiating oral hypoglycemics between 2007 and 2009. MAIN MEASURES: We used group-based trajectory models to identify trajectories of oral hypoglycemics in the 12 months post-treatment initiation, using monthly proportion of days covered (PDC) as the adherence measure. Multivariable Cox proportional hazard models were used to examine the association between trajectories and time to first diabetes-related hospitalization/emergency department (ED) visits in the following year. We used the C-index to compare prediction performance between adherence trajectories and dichotomous cutpoints (annual PDC <80 vs. ≥80 %). RESULTS: The mean annual PDC was 0.58 (SD 0.32). Seven trajectories were identified: perfect adherers (9 % of the cohort), nearly perfect adherers (31.4 %), moderate adherers (21.0 %), low adherers (11.0 %), late discontinuers (6.8 %), early discontinuers (9.7 %), and non-adherers with only one fill (11.1 %). Compared to perfect adherers, trajectories of moderate adherers (HR = 1.48, 95 % CI 1.25, 1.75), low adherers (HR = 1.51, 95 % CI 1.25, 1.83), and non-adherers with only one fill (HR = 1.35, 95 % CI 1.09, 1.67) had greater risk of diabetes-related hospitalizations/ED visits. Predictive accuracy was improved using trajectories compared to dichotomized cutpoints (C-index = 0.714 vs. 0.652). CONCLUSIONS: Oral hypoglycemic treatment trajectories were highly variable in this large Medicaid cohort. Low and moderate adherers and those filling only one prescription had a modestly higher risk of hospitalizations/ED visits compared to perfect adherers. Trajectory models may be valuable in identifying specific non-adherence patterns for targeting interventions.

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Section: Study Design and Cohortmentioning

confidence: 99%

Section: Outcome Measuresmentioning

confidence: 99%

Trajectories of Diabetes Medication Adherence and Hospitalization Risk: A Retrospective Cohort Study in a Large State Medicaid Program

et al. 2016

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“…We calculated the MPR as the sum of the days' supply of antiplatelet medications divided by 365 days. 34 We considered adherence as appropriate based on a MPR≥0.80. 33,35 This cutoff corresponds to the subject having medication available 80 % or more during the 12 month follow-up period.…”

Section: Outcome Measures Primary Endpoint: Adherence To Antiplateletmentioning

confidence: 99%

Can Phone-Based Motivational Interviewing Improve Medication Adherence to Antiplatelet Medications After a Coronary Stent Among Racial Minorities? A Randomized Trial

et al. 2014

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BACKGROUND:Minorities have lower adherence to cardiovascular medications and have worst cardiovascular outcomes post coronary stent placement OBJECTIVE: The aim of this study is to compare the efficacy of phone-delivered Motivational Interviewing (MINT) to an educational video at improving adherence to antiplatelet medications among insured minorities. DESIGN: This was a randomized study. PARTICIPANTS: We identified minorities with a recently placed coronary stent from an administrative data set by using a previously validated algorithm. INTERVENTIONS: MINT subjects received quarterly phone calls and the DVD group received a one-time mailed video. MAIN MEASURES: Outcome variables were collected at baseline and at 12-month post-stent, using surveys and administrative data. The primary outcome was antiplatelet (clopidogrel and prasugrel) adherence measured by Medication Possession Ratio (MPR) and self-reported adherence (Morisky score). We also measured appropriate adherence defined as an MPR ≥ 0.80. KEY RESULTS: We recruited 452 minority subjects with a new coronary stent (44 % Hispanics and 56 % Black). The patients had a mean age of 69.5±8.8, 58 % were males, 78 % had an income lower than $30,000 per year and only 22 % had achieved high school education or higher. The MPR for antiplatelet medications was 0.77 for the MINT group compared to 0.70 for the DVD group (p<0.05). The percentage of subjects with adequate adherence to their antiplatelet medication was 64 % in the MINT group and 50 % in the DVD group (p<0.01). Self-reported adherence at 12 months was higher in the MINT group compared to the DVD group (p<0.01). Results were similar among drug-eluting stent (DES) recipients. CONCLUSIONS: Among racial minorities, a phone-based motivational interview is effective at improving adherence to antiplatelet medications post coronary stent placement. Phone-based MINT seems to be a promising and cost-effective strategy to modify risk behaviors among minority populations at high cardiovascular risk. BACKGROUNDThe safe use of coronary stents requires the daily use of thienopyridines for 3 to 12 months after percutaneous coronary intervention (PCI). 1 The premature discontinuation of these medications 1 is associated with an increased risk of instent thrombosis, cardiovascular events and death. 2-6 Unfortunately, lack of medication adherence is common and is associated with significant health care costs and mortality. 7,8 Vulnerable groups such as racial minorities and the elderly have a higher risk of poor adherence. 5,6,9,10 In the case of antiplateletet medications, blacks are more likely to not receive a clopidogrel prescription 11 or to not fill it after PCI. Further, our prior analyses of insurer claims data showed that minority populations were less adherent to antiplatelet medications post drug-eluting stent (DES) placement. 12 The lack of appropriate use of evidence-based therapies after PCI may partially contribute to the excess morbidity and mortality reported among minorities. 13,14,6 The improvement of med...

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“…The medication possession ratio, a refill-based adherence measure that is based on administrative pharmacy refill data (Hess et al, 2006) was calculated for the year before and the year after baseline. Medication possession ratios greater than 0.80 are considered adherent, and 1.0 represents perfect adherence.…”

Section: Data Elementsmentioning

confidence: 99%

Association of Health Literacy With Medication Knowledge, Adherence, and Adverse Drug Events Among Elderly Veterans

Mosher

Lund

Kripalani

et al. 2012

Journal of Health Communication

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Measurement of Adherence in Pharmacy Administrative Databases: A Proposal for Standard Definitions and Preferred Measures

Cited by 654 publications

References 25 publications

Trajectories of Diabetes Medication Adherence and Hospitalization Risk: A Retrospective Cohort Study in a Large State Medicaid Program

Trajectories of Diabetes Medication Adherence and Hospitalization Risk: A Retrospective Cohort Study in a Large State Medicaid Program

Can Phone-Based Motivational Interviewing Improve Medication Adherence to Antiplatelet Medications After a Coronary Stent Among Racial Minorities? A Randomized Trial

Association of Health Literacy With Medication Knowledge, Adherence, and Adverse Drug Events Among Elderly Veterans

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