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

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.

Informations de copyright

Copyright ©The authors 2023.

Déclaration de conflit d'intérêts

Conflict of interest: Outside this manuscript, J.K. Quint received grants paid to her institution from the Medical Research Council, Health Data Research UK, GlaxoSmithKline, Boehringer Ingelheim, Asthma + Lung UK and AstraZeneca, and consulting fees from GlaxoSmithKline, Evidera, AstraZeneca and Insmed. None of which are related to the content of this work. Outside this manuscript, K. Verhamme received unconditional research grants paid to her institution from Chiesi, Amgen, Union Chimique Belge (UCB), Johnson & Johnson (J&J) and the European Medicines Agency (EMA). None of which are related to the content of this work. Outside this manuscript, L. Lahousse received a consulting fee paid to her institution from AstraZeneca and honoraria for lectures paid to her institution from Chiesi and IPSA vzw, a non-profit organisation facilitating lifelong learning for healthcare providers. L. Lahousse is an unpaid member of European Respiratory Society and Belgian Respiratory Society, member of Faculty board of Ghent University – Faculty of Pharmaceutical Sciences and faculty committees. None of which are related to the content of this work. All other authors declare no competing interests.