Contrasting Measures of Adherence with Simple Drug Use, Medication Switching, and Therapeutic Duplication
Contrasting Measures of Adherence with Simple Drug Use, Medication Switching, and Therapeutic Duplication
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DOI：
10.1345/aph.1k671
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发表时间：
2009-01-01
影响因子：
2.9
通讯作者：
Sleath, Betsy Lynn
中科院分区：
文献类型：
--
作者：
Martin, Bradley C.;Wiley-Exley, Elizabeth K.;Sleath, Betsy Lynn
背景技术背景：研究文献中报告了多种依从性措施，很难确定哪种是最好的，因为每种措施都有细微差别。药物转换和多药或治疗重复的发生可以大大复杂的依从性计算时，坚持一个治疗class.Objective. Objective：对比的比例天覆盖（PDC）的依从性指标与2种变量的药物拥有率（MPR，截断MPR）。方法：本研究是对1999年7月至2000年6月北卡罗来纳州医疗补助行政索赔数据的回顾性分析。不属于健康维护组织、未住院、未怀孕、服用至少一种抗精神病药物的精神分裂症患者（ICD-9-CM代码295.xx）的数据按每人汇总为人-季度。PDC的分子定义为一种或多种抗精神病药物可用的天数，MPR分子定义为抗精神病药物供应的总天数;两者均除以每个人-季度的总天数。估计仅使用一种抗精神病药物，转换药物，或有治疗重复的quart.Results：最终样本包括25,200人季度从7069人的受试者的依从率。对于单用抗精神病药的人群，对抗精神病药的依从性为：PDC 0.607，截断MPR 0.640和MPR 0.695（p < 0.001）。对于转换的人宿舍，平均MPR为0.690，截断MPR为0.624，PDC为0.562（p < 0.001）。在存在治疗性重复时，PDC为0.669，截断MPR为0.774，MPR为1.238结论：在所有类型的使用者中，PDC比MPR提供了一个更保守的依从性估计;然而，两种方法之间的差异对于转换治疗和处方治疗重复的人来说更显著，MPR可能夸大了真实的依从性。当寻求对一类药物的依从性的测量时，应考虑PDC，特别是在一类药物中的多种药物经常同时使用的临床情况下。
BACKGROUND: Multiple measures of adherence have been reported in the research literature and it is difficult to determine which is best, as each is nuanced. Occurrences of medication switching and polypharmacy or therapeutic duplication can substantially complicate adherence calculations when adherence to a therapeutic class is sought.OBJECTIVE: To contrast the Proportion of Days Covered (PDC) adherence metric with 2 variants of the Medication Possession Ratio (MPR, truncated MPR).METHODS: This study was a retrospective analysis of the North Carolina Medicaid administrative claims data from July 1999 to June 2000. Data for patients with schizophrenia (ICD-9-CM code 295.xx) who were not part of a health maintenance organization, not hospitalized, and not pregnant, taking at least one antipsychotic, were aggregated for each person into person-quarters. The numerator for PDC was defined as the number of days one or more antipsychotics was available and the MPR numerator was defined as the total days' supply of antipsychotics; both were divided by the total days in each person-quarter. Adherence rates were estimated for subjects who used only one antipsychotic, switched medications, or had therapeutic duplication in the quarter.RESULTS: The final sample consisted of 25,200 person-quarters from 7069 individuals. For person-quarters with single antipsychotic use, adherence to antipsychotics as a class was: PDC 0.607, truncated MPR 0.640, and MPR 0.695 (p < 0.001). For person-quarters with switching, the average MPR was 0.690, truncated MPR was 0.624, and PDC was 0.562 (p < 0.001). In the presence of therapeutic duplication, the PDC was 0.669, truncated MPR was 0.774, and MPR was 1.238 (p < 0.001).CONCLUSIONS: The PDC provides a more conservative estimate of adherence than the MPR across all types of users; however, the differences between the 2 methods are more substantial for persons switching therapy and prescribed therapeutic duplication, where MPR may overstate true adherence. The PDC should be considered when a measure of adherence to a class of medications is sought, particularly in clinical situations in which multiple medications within a class are often used concurrently.