Comparison of Pharmacy Refill Data With Chemical Adherence Testing in Assessing Medication Nonadherence in a Safety Net Hospital Setting.
Comparison of Pharmacy Refill Data With Chemical Adherence Testing in Assessing Medication Nonadherence in a Safety Net Hospital Setting.
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DOI：
10.1161/jaha.122.027099
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发表时间：
2022-10-04
影响因子：
5.4
通讯作者：
Vongpatanasin, Wanpen
中科院分区：
文献类型：
--
作者：
Osula, David;Wu, Bryan;Schesing, Kevin;Das, Sandeep R.;Moss, Elizabeth;Alvarez, Kristin;Clark, Christopher;Halm, Ethan A.;Brown, Nancy J.;Vongpatanasin, Wanpen
关键词：
药房填充数据是评估药物不依从性的实用工具。然而，以前的研究没有比较药房填充数据的准确性，血浆药物水平的测量，或化学粘附试验（CAT）。我们在安全网卫生系统门诊不受控制的高血压患者中进行了一项横断面研究。采集血浆样本，采用液相色谱质谱法测定常见心血管药物，包括钙通道阻滞剂、噻嗪类利尿剂、β受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和他汀类药物。覆盖天数比例（PDC）是一种跟踪药房填充数据的方法，通过与Surescripts的链接计算，并将其诊断测试特征与CAT进行比较。在77例未控制的高血压患者中，13例（17%）未依从至少1种降压药，23例（37%）仅在接受血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂或他汀类药物治疗的患者中，未依从组的PDC显著低于依从组（均P<0.05），但在处方其他药物类别的患者中没有。PDC检测CAT对血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和他汀类药物不依从的敏感性和特异性分别为75%-82%和56%-79%。PDC检测不依从性的阳性预测值对于降压药仅为11%-27%，对于他汀类药物为45%。PDC可用于检测对血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和他汀类药物的不依从性，但在检测对钙通道阻滞剂、β受体阻滞剂或噻嗪类利尿剂的不依从性方面的作用有限，并且对所有药物类别的阳性预测值均较低。
Pharmacy fill data are a practical tool for assessing medication nonadherence. However, previous studies have not compared the accuracy of pharmacy fill data to measurement of plasma drug levels, or chemical adherence testing (CAT). We performed a cross‐sectional study in patients with uncontrolled hypertension in outpatient clinics in a safety net health system. Plasma samples were obtained for measurement of common cardiovascular drugs, including calcium channel blockers, thiazide diuretics, beta blockers, angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, and statins, using liquid chromatography mass spectrometry. Proportion of days covered (PDC), a method for tracking pharmacy fill data, was calculated via linkages with Surescripts, and its diagnostic test characteristics were compared with CAT. Among 77 patients with uncontrolled hypertension, 13 (17%) were nonadherent to at least 1 antihypertensive drug and 23 (37%) were nonadherent to statins by CAT. PDC was significantly lower in the nonadherent versus the adherent group by CAT only among patients prescribed an angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker or statin (all P<0.05) but not in patients prescribed other drug classes. The sensitivity and specificity of PDC in detecting nonadherence to angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers and statin drugs by CAT were 75% to 82% and 56% to 79%, respectively. The positive predictive value of PDC in detecting nonadherence was only 11% to 27% for antihypertensive drugs and 45% for statins. PDC is useful in detecting nonadherence to angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers and statins but has limited usefulness in detecting nonadherence to calcium channel blockers, beta blockers, or thiazide diuretics and has a low positive predictive value for all drug classes.