Estimating medication adherence from Electronic Health Records: comparing methods for mining and processing asthma treatment prescriptions.
Adherence
Asthma
Compliance
Corticosteroid
Electronic Health Records
Journal
BMC medical research methodology
ISSN: 1471-2288
Titre abrégé: BMC Med Res Methodol
Pays: England
ID NLM: 100968545
Informations de publication
Date de publication:
12 07 2023
12 07 2023
Historique:
received:
05
09
2022
accepted:
26
04
2023
medline:
14
7
2023
pubmed:
13
7
2023
entrez:
12
7
2023
Statut:
epublish
Résumé
Medication adherence is usually defined as the extent of the agreement between the medication regimen agreed to by patients with their healthcare provider and the real-world implementation. Proactive identification of those with poor adherence may be useful to identify those with poor disease control and offers the opportunity for ameliorative action. Adherence can be estimated from Electronic Health Records (EHRs) by comparing medication dispensing records to the prescribed regimen. Several methods have been developed in the literature to infer adherence from EHRs, however there is no clear consensus on what should be considered the gold standard in each use case. Our objectives were to critically evaluate different measures of medication adherence in a large longitudinal Scottish EHR dataset. We used asthma, a chronic condition with high prevalence and high rates of non-adherence, as a case study. Over 1.6 million asthma controllers were prescribed for our cohort of 91,334 individuals, between January 2009 and March 2017. Eight adherence measures were calculated, and different approaches to estimating the amount of medication supply available at any time were compared. Estimates from different measures of adherence varied substantially. Three of the main drivers of the differences between adherence measures were the expected duration (if taken as in accordance with the dose directions), whether there was overlapping supply between prescriptions, and whether treatment had been discontinued. However, there are also wider, study-related, factors which are crucial to consider when comparing the adherence measures. We evaluated the limitations of various medication adherence measures, and highlight key considerations about the underlying data, condition, and population to guide researchers choose appropriate adherence measures. This guidance will enable researchers to make more informed decisions about the methodology they employ, ensuring that adherence is captured in the most meaningful way for their particular application needs.
Sections du résumé
BACKGROUND
Medication adherence is usually defined as the extent of the agreement between the medication regimen agreed to by patients with their healthcare provider and the real-world implementation. Proactive identification of those with poor adherence may be useful to identify those with poor disease control and offers the opportunity for ameliorative action. Adherence can be estimated from Electronic Health Records (EHRs) by comparing medication dispensing records to the prescribed regimen. Several methods have been developed in the literature to infer adherence from EHRs, however there is no clear consensus on what should be considered the gold standard in each use case. Our objectives were to critically evaluate different measures of medication adherence in a large longitudinal Scottish EHR dataset. We used asthma, a chronic condition with high prevalence and high rates of non-adherence, as a case study.
METHODS
Over 1.6 million asthma controllers were prescribed for our cohort of 91,334 individuals, between January 2009 and March 2017. Eight adherence measures were calculated, and different approaches to estimating the amount of medication supply available at any time were compared.
RESULTS
Estimates from different measures of adherence varied substantially. Three of the main drivers of the differences between adherence measures were the expected duration (if taken as in accordance with the dose directions), whether there was overlapping supply between prescriptions, and whether treatment had been discontinued. However, there are also wider, study-related, factors which are crucial to consider when comparing the adherence measures.
CONCLUSIONS
We evaluated the limitations of various medication adherence measures, and highlight key considerations about the underlying data, condition, and population to guide researchers choose appropriate adherence measures. This guidance will enable researchers to make more informed decisions about the methodology they employ, ensuring that adherence is captured in the most meaningful way for their particular application needs.
Identifiants
pubmed: 37438684
doi: 10.1186/s12874-023-01935-3
pii: 10.1186/s12874-023-01935-3
pmc: PMC10337150
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
167Subventions
Organisme : Medical Research Council
ID : MC_PC_19004
Pays : United Kingdom
Informations de copyright
© 2023. The Author(s).
Références
N Engl J Med. 2018 May 17;378(20):1865-1876
pubmed: 29768149
J Allergy Clin Immunol Pract. 2018 Nov - Dec;6(6):1989-1998.e3
pubmed: 29627457
Med Care. 2005 Jun;43(6):521-30
pubmed: 15908846
Int J Clin Pharm. 2014 Feb;36(1):55-69
pubmed: 24166659
Am Health Drug Benefits. 2009 Jun;2(4):174-80
pubmed: 25126289
J Allergy Clin Immunol. 2004 Jul;114(1):40-7
pubmed: 15241342
Curr Med Res Opin. 2020 Sep;36(9):1549-1557
pubmed: 32634043
J Epidemiol Community Health. 1986 Jun;40(2):121-9
pubmed: 3746173
Br J Clin Pharmacol. 2021 Mar;87(3):825-836
pubmed: 32639589
J Affect Disord. 2011 Apr;130(1-2):46-52
pubmed: 20950862
Eur Respir J. 2015 Feb;45(2):396-407
pubmed: 25323234
Am Rev Respir Dis. 1993 Oct;148(4 Pt 2):S1-26
pubmed: 8214958
J Am Pharm Assoc (2003). 2012 May-Jun;52(3):381-97
pubmed: 22618980
BMC Med Res Methodol. 2020 Dec 10;20(1):303
pubmed: 33302885
Heart. 2013 Apr;99(8):562-9
pubmed: 23434769
J Bras Pneumol. 2014 Jul-Aug;40(4):364-72
pubmed: 25210958
AIDS Behav. 2013 Jan;17(1):284-97
pubmed: 22407465
Curr Med Res Opin. 2022 Dec;38(12):2055-2067
pubmed: 36239574
J Int AIDS Soc. 2017 Mar 22;20(1):21371
pubmed: 28630651
J Am Acad Dermatol. 2004 Aug;51(2):212-6
pubmed: 15280839
BMC Health Serv Res. 2012 Jun 12;12:155
pubmed: 22691240
N Engl J Med. 2018 May 17;378(20):1877-1887
pubmed: 29768147
Drugs Aging. 2015 Mar;32(3):217-25
pubmed: 25749743
J Am Med Inform Assoc. 2015 Jan;22(1):43-50
pubmed: 25342177
Pharmacoeconomics. 2018 Mar;36(3):369-380
pubmed: 29230712
Eur Heart J. 2019 Jul 1;40(25):2070-2085
pubmed: 29992264
Patient Prefer Adherence. 2017 Jun 02;11:1009-1017
pubmed: 28652710
BMJ Open. 2017 Sep 15;7(9):e015108
pubmed: 28918407
Int J Epidemiol. 2016 Jun;45(3):714-715f
pubmed: 27165758
J Asthma Allergy. 2018 Aug 29;11:193-204
pubmed: 30214247
J Manag Care Pharm. 2009 Nov-Dec;15(9):728-40
pubmed: 19954264
Am J Med. 2010 Nov;123(11):1001-6
pubmed: 20870201
J Gen Intern Med. 2010 Apr;25(4):284-90
pubmed: 20131023
Eur Respir J. 2000 Nov;16(5):802-7
pubmed: 11153575
Thorax. 2012 Aug;67(8):751-3
pubmed: 22436168
Allergy. 2009 Oct;64(10):1458-1462
pubmed: 19416142
J Allergy Clin Immunol Pract. 2021 Dec;9(12):4239-4242
pubmed: 34352449
Int J Med Inform. 2020 Apr;136:104092
pubmed: 32062562
J Allergy Clin Immunol. 2007 Nov;120(5):1153-9
pubmed: 17936894
BMJ Open. 2018 May 20;8(5):e023289
pubmed: 29780034
Drug Saf. 2012 Jan;35 Suppl 1:73-87
pubmed: 23446788
Clin Pharmacokinet. 2002;41(1):1-6
pubmed: 11825093
Cochrane Database Syst Rev. 2017 Mar 13;3:CD012286
pubmed: 28288272
Respir Res. 2018 Apr 27;19(1):75
pubmed: 29699563
J Allergy Clin Immunol Pract. 2016 Sep-Oct;4(5):802-12
pubmed: 27587314
Int J Chron Obstruct Pulmon Dis. 2010 Aug 09;5:241-9
pubmed: 20714378
Eur J Clin Pharmacol. 2017 Jan;73(1):91-97
pubmed: 27695918
J Allergy Clin Immunol. 1998 Oct;102(4 Pt 1):531-8
pubmed: 9802359
BMJ Open. 2018 Jan 21;8(1):e016982
pubmed: 29358417
Eur J Cancer. 2012 Sep;48(13):1939-46
pubmed: 22464016
Drug Alcohol Depend. 2016 Jun 01;163:24-30
pubmed: 27068252
Arch Intern Med. 2000 Nov 27;160(21):3278-85
pubmed: 11088090
N Engl J Med. 2000 Aug 3;343(5):332-6
pubmed: 10922423
S Afr Med J. 2020 Aug 31;110(9):932-936
pubmed: 32880281
J Allergy Clin Immunol. 2004 Dec;114(6):1288-93
pubmed: 15577825
Ann Pharmacother. 2006 Jul-Aug;40(7-8):1280-88
pubmed: 16868217
J Med Econ. 2019 Jun;22(6):554-566
pubmed: 30663455
Ann Am Thorac Soc. 2015 Feb;12(2):161-6
pubmed: 25569765
Lancet. 2005 Dec 10;366(9502):2005-11
pubmed: 16338449
BMC Public Health. 2012 Mar 19;12:204
pubmed: 22429515
Eur Respir J. 2021 Sep 2;58(3):
pubmed: 34475112
N Engl J Med. 2005 Aug 4;353(5):487-97
pubmed: 16079372