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A method for calculating adherence to polypharmacy from dispensing data records.
Isabelle Arnet1, Ivo Abraham, Markus Messerli
1Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstr. 50, 4056, Basel, Switzerland, isabelle.arnet@unibas.ch.
A new method, the daily polypharmacy possession ratio (DPPR), accurately measures medication adherence for patients with multiple prescriptions. This improves upon the medication possession ratio (MPR) by accounting for the complexities of polypharmacy.
Area of Science:
- Pharmacoeconomics and Pharmacoepidemiology
- Health Services Research
Background:
- Existing medication adherence measures, such as the medication possession ratio (MPR), are inconsistently applied and may inaccurately estimate adherence for patients on multiple medications (polypharmacy).
- The nomenclature and computation of adherence measures vary, leading to potential over- or underestimation of true adherence rates.
Purpose of the Study:
- To evaluate the impact of different parameters on the MPR for single-medication regimens.
- To establish standards for assessing adherence in polypharmacy.
- To introduce and validate a novel method for calculating polypharmacy adherence.
Main Methods:
- Simulated variations in the MPR formula to understand its behavior.
- Defined standards for polypharmacy adherence estimation.
- Developed the daily polypharmacy possession ratio (DPPR) as a new adherence metric.
- Assessed the face validity of DPPR using three patient case studies from pharmacy refill data.
Main Results:
- The standard MPR is influenced by factors like observation period, medication gaps, and overlaps, and often overestimates adherence in polypharmacy.
- The proposed daily polypharmacy possession ratio (DPPR) calculates adherence by assessing medication availability on a daily basis, considering multiple drugs.
- Comparative analysis showed DPPR yielded different adherence rates (75%, 88%, 99%) compared to MPR (80%, 90%, 89%) for the illustrative cases, highlighting MPR's inaccuracies.
Conclusions:
- The DPPR offers a more precise measure of polypharmacy adherence by accounting for medication number, switching, duplication, and overlap.
- Further research is recommended to validate the DPPR's accuracy and clinical utility.
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