Predicting adherence trajectory using initial patterns of medication filling.
Predicting adherence trajectory using initial patterns of medication filling.
复制标题
使用药物填充的初始模式预测依从轨迹。
DOI：
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发表时间：
2015
影响因子：
3.2
通讯作者：
N. Choudhry
中科院分区：
文献类型：
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作者：
J. Franklin;A. Krumme;W. Shrank;O. Matlin;T. Brennan;N. Choudhry
目标
评价初始药物分配预测长期依从性模式的能力。
研究设计
一项回顾性队列研究，对2005年至2008年CVS Caremark的医疗保险D部分药物计划中招募的他汀类药物启动者进行了研究。
方法
我们使用基于组的轨迹模型，根据治疗开始后一年内他汀类药物填充的模式，将患者分为6个依从性轨迹。基线临床特征和开始后前2至4个月内他汀类药物填充的指标用于预测logistic回归模型中的依从性轨迹，分别在初始他汀类药物分发日供应的分层内。交叉验证用于测量模型在未用于模型估计的数据中的预测准确性。
结果
在77，703例他汀类药物启动者中，仅使用基线变量的预测效果较差（交叉验证的C统计量≤ 0.61）。当使用3个月的初始依从性来预测轨迹时，在指数供应≤30天的患者中，预测大大提高（0.62 ≤ C ≤ 0.91）。在模型中初始依从性为4个月时，所有患者的预测均较强（C ≥ 0.72），尤其是最佳和最差轨迹（在指标供应≤ 30天的患者中，C = 0.90和0.94;在指标供应> 30天的患者中，C = 0.83和0.90）。
结论
初始填充行为强烈预测未来的粘附轨迹。预测依从性轨迹可能有助于更好地将干预措施瞄准最有可能受益的患者。
OBJECTIVES
To evaluate the ability of initial medication dispensings to predict long-term patterns of adherence.
STUDY DESIGN
A retrospective cohort study of statin initiators enrolled in a Medicare Part D drug plan from CVS Caremark from 2005 to 2008.
METHODS
We used group-based trajectory models to classify patients into 6 adherence trajectories based on patterns of statin filling over the year following therapy initiation. Baseline clinical characteristics and indicators of statin filling during the first 2 to 4 months following initiation were used to predict adherence trajectory in logistic regression models, separately within strata of the days' supply of the initial statin dispensing. Cross-validation was used to measure predictive accuracy of models in data not used for model estimation.
RESULTS
Among 77,703 statin initiators, prediction using baseline variables only was poor (cross-validated C statistic ≤ 0.61). When using 3 months of initial adherence to predict trajectory, prediction was greatly improved among patients with an index supply ≤30 days (0.62 ≤ C ≤ 0.91). With 4 months of initial adherence in the model, prediction was strong for all patients (C ≥ 0.72), especially for the best and worst trajectories (C = 0.90 and 0.94, respectively, in patients with an index supply ≤ 30 days; and C = 0.83 and 0.90, respectively, in patients with an index supply > 30 days).
CONCLUSIONS
Initial filling behavior strongly predicted future adherence trajectory. Predicting adherence trajectories may facilitate better targeting of interventions to patients most likely to benefit.
我们能否确定药物依从性的临床预测因素……我们应该吗？
影响因子：
3
作者：
Steiner,JohnF
通讯作者：
Steiner,JohnF
影响因子：
5.7
作者：
Hong, Song-Iee;Hasche, Leslie;Bowland, Sharon
通讯作者：
Bowland, Sharon