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Comparison of various measures for assessing medication refill adherence using prescription data
N M Vink1, O H Klungel, R P Stolk
1Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Pharmacoepidemiology and Drug Safety
|December 26, 2008
Summary
Comparing medication refill adherence measures in type 2 diabetes patients shows that drug class-level calculations, specifically medication possession ratio per year (MPRY) and gaps between refills (GAP), are effective for multiple-drug regimens.
Area of Science:
- Pharmacoeconomics and Health Outcomes Research
- Diabetes Mellitus Management
- Cardiovascular Risk Management
Background:
- Accurate estimation of medication refill adherence is crucial, especially for patients with multiple chronic conditions.
- Existing adherence measures using prescription data lack direct comparison, particularly in patients managing multiple medications.
- Understanding the accuracy of different adherence measures in diverse drug regimens is essential for effective patient care.
Purpose of the Study:
- To compare various calculation methods for assessing medication refill adherence using prescription data.
- To evaluate the accuracy of different adherence measures in patients with type 2 diabetes on multiple drug classes.
- To identify the most reliable methods for estimating adherence in complex medication regimens.
Main Methods:
- An observational cohort study of 3877 type 2 diabetes patients was conducted, assessing adherence to oral glucose-lowering, antihypertensive, and lipid-lowering medications.
- Medication possession ratios (MPR) and gaps between refills (GAP) were calculated at both drug class and therapeutic levels.
- Receiver operating characteristic (ROC) curve analysis, specifically Area Under the Curve (AUC), was used to compare the discriminative ability of different adherence measures.
Main Results:
- Adherence measures calculated at the drug class level demonstrated significantly larger AUC values (0.85-0.90) compared to the therapeutic level (0.72-0.90).
- For oral glucose-regulating and antihypertensive medications, the medication possession ratio per year (MPRY) and GAP measures showed the highest AUC (0.87-0.88).
- The GAP measure yielded the largest AUC (0.90) for lipid-lowering medication adherence.
Conclusions:
- Adherence calculation at the drug class level is favored over the therapeutic level due to superior accuracy.
- Both medication possession ratio per year (MPRY) and gaps between refills (GAP) are effective measures for identifying suboptimal refill adherence in patients using multiple medications.
- The findings support the use of specific adherence calculation methods for improved patient management in type 2 diabetes.
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