Methods to assess COPD medications adherence in healthcare databases: a systematic review

Abstract

Background:The Global Initiative for Chronic Obstructive Lung Disease 2023 report recommends medication adherence assessment in COPD as an action item. Healthcare databases provide opportunities for objective assessments; however, multiple methods exist. We aimed to systematically review the literature to describe existing methods to assess adherence in COPD in healthcare databases and to evaluate the reporting of influencing variables.Method:We searched MEDLINE, Web of Science and Embase for peer-reviewed articles evaluating adherence to COPD medication in electronic databases, written in English, published up to 11 October 2022 (PROSPERO identifier CRD42022363449). Two reviewers independently conducted screening for inclusion and performed data extraction. Methods to assess initiation (dispensing of medication after prescribing), implementation (extent of use over a specific time period) and/or persistence (time from initiation to discontinuation) were listed descriptively. Each included study was evaluated for reporting variables with an impact on adherence assessment: inpatient stays, drug substitution, dose switching and early refills.Results:160 studies were included, of which four assessed initiation, 135 implementation and 45 persistence. Overall, one method was used to measure initiation, 43 methods for implementation and seven methods for persistence. Most of the included implementation studies reported medication possession ratio, proportion of days covered and/or an alteration of these methods. Only 11% of the included studies mentioned the potential impact of the evaluated variables.Conclusion:Variations in adherence assessment methods are common. Attention to transparency, reporting of variables with an impact on adherence assessment and rationale for choosing an adherence cut-off or treatment gap is recommended.

Potential marker genes for chronic obstructive pulmonary disease revealed based on single-cell sequencing and Mendelian randomization analysis

“…All data analyses were conducted in R version 4.0. MR analysis follows three fundamental assumptions: [ 1 ] the correlation assumption, stating that the instrumental variable is closely related to the exposure factor, but not to the outcome; [ 2 ] the independence assumption, meaning that the instrumental variable and the confounder have no relationship; and [ 3 ] the exclusion assumption, stating that the instrumental variable only affects the outcome through the exposure factor. If the instrumental variable affects the outcome through other pathways, it is considered to be genetic pleiotropy.…”

“…Chronic inflammation in the periphery of the bronchi and fine bronchioles could lead to lung tissue destruction, fibrosis and emphysema. Continued progression of COPD leads to deterioration of the patient’s condition and a corresponding increase in healthcare costs and mortality [ 2 ]. However, to date, there is no satisfactory therapeutic regimen that can slow the progression of COPD or reduce mortality [ 3 ], and one important reason for this is that the underlying pathogenesis of COPD is complex.…”