Surveillance of medication use: early identification of poor adherence
Open Access
- 19 November 2011
- journal article
- Published by Oxford University Press (OUP) in Journal of the American Medical Informatics Association
- Vol. 19 (4), 649-654
- https://doi.org/10.1136/amiajnl-2011-000416
Abstract
Background We sought to measure population-level adherence to antihyperlipidemics, antihypertensives, and oral hypoglycemics, and to develop a model for early identification of subjects at high risk of long-term poor adherence. Methods Prescription-filling data for 2 million subjects derived from a payor's insurance claims were used to evaluate adherence to three chronic drugs over 1 year. We relied on patterns of prescription fills, including the length of gaps in medication possession, to measure adherence among subjects and to build models for predicting poor long-term adherence. Results All prescription fills for a specific drug were sequenced chronologically into drug eras. 61.3% to 66.5% of the prescription patterns contained medication gaps >30 days during the first year of drug use. These interrupted drug eras include long-term discontinuations, where the subject never again filled a prescription for any drug in that category in the dataset, which represent 23.7% to 29.1% of all drug eras. Among the prescription-filling patterns without large medication gaps, 0.8% to 1.3% exhibited long-term poor adherence. Our models identified these subjects as early as 60 days after the first prescription fill, with an area under the curve (AUC) of 0.81. Model performance improved as the predictions were made at later time-points, with AUC values increasing to 0.93 at the 120-day time-point. Conclusions Dispensed medication histories (widely available in real time) are useful for alerting providers about poorly adherent patients and those who will be non-adherent several months later. Efforts to use these data in point of care and decision support facilitating patient are warranted.Keywords
This publication has 40 references indexed in Scilit:
- Medication Use in Older PatientsJAMA, 2010
- Can adherence to antihypertensive therapy be used to promote adherence to statin therapy?Patient Preference and Adherence, 2009
- An Empirical Basis for Standardizing Adherence Measures Derived From Administrative Claims Data Among Diabetic PatientsMedical Care, 2008
- Adherence with single-pill amlodipine/atorvastatin vs a two-pill regimen2008
- Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing historiesBMJ, 2008
- Adherence to MedicationNew England Journal of Medicine, 2005
- Medication adherence: a key factor in achieving blood pressure control and good clinical outcomes in hypertensive patientsCurrent Opinion in Cardiology, 2004
- Hospital Admissions Resulting from Preventable Adverse Drug ReactionsAnnals of Pharmacotherapy, 2002
- Practical approach to determining costs and frequency of adverse drug events in a health care networkAmerican Journal of Health-System Pharmacy, 2001
- Medication nonadherence--Part I: The health and humanistic consequences.1998