Remission in Pediatric Inflammatory Bowel Disease Correlates With Prescription Refill Adherence Rates
Charles M Samson1, Douglas Mager, Sharon Frazee
1*Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University in St Louis School of Medicine †Express Scripts ‡Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, MO.
Insights
Pediatric inflammatory bowel disease (IBD) patients with better medication refill adherence showed improved clinical remission. Addressing nonadherence in pediatric IBD can enhance patient outcomes.
Area of Science:
- Gastroenterology
- Pediatric Health
- Health Outcomes Research
Background:
- Pediatric inflammatory bowel disease (IBD) management requires consistent medication adherence for optimal clinical outcomes.
- Assessing medication refill adherence in pediatric IBD patients is crucial for understanding treatment effectiveness.
Purpose of the Study:
- To evaluate medication refill adherence in pediatric IBD patients using pharmacy benefit management (PBM) prescription claims data.
- To correlate adherence rates with clinical outcomes in pediatric IBD.
Main Methods:
- Utilized PBM prescription claims data and electronic health records for 362 pediatric IBD patients.
- Calculated medication possession ratio (MPR) and assessed adherence dichotomously (≥80% vs. <80%).
- Correlated MPR with physician global assessment (PGA) for clinical remission status.
Main Results:
- A significant association was found between refill adherence and clinical remission in pediatric IBD.
- 40% of eligible patients achieved an MPR of 80% or higher.
- Patients in remission had a higher mean MPR compared to those with active disease (0.72 vs. 0.51, P=0.002).
Conclusions:
- Nonadherence to IBD medications is prevalent in pediatric patients, particularly adolescents.
- Improving adherence through PBM data monitoring and interventions can potentially enhance clinical outcomes in pediatric IBD.
Objectives:
The aim of the study was to use pharmacy benefit management (PBM) prescription claims data to assess refill adherence in pediatric inflammatory bowel disease (IBD) and correlate adherence with clinical outcomes in pediatric IBD.
Methods:
We identified 362 pediatric patients with IBD seen at Washington University from 9/1/2012 to 8/31/2013 and matched them within Express Scripts' member eligibility files for clients allowing use of prescription drug data for research purposes. Maintenance IBD medication possession ratios (MPR) were determined through PBM prescription claims data and chart review. Demographic and prospectively captured physician global assessments (PGA) were retrospectively extracted from the medical record. MPR was analyzed as continuous data and also dichotomized as greater or less than 80%.
Results:
Among our 362 patients, we matched 228 (63%) within Express Scripts' eligibility data files. Of those, 78 patients were continuously eligible for benefits and had at least one outpatient prescription IBD medication prescribed. Their mean MPR was 0.63 ± 0.31 (standard deviation) and 40% had an MPR ≥80%. Patients in clinical remission had a higher mean MPR than those with an active PGA (0.72 ± 0.28 vs 0.51 ± 0.32, P = 0.002) and patients whose MPR were ≥80% were more likely to have a PGA of remission than those with whose MPR were <80% (84% vs 43%, P = <0.001).
Conclusions:
We found a significant association between refill adherence and clinical remission. Nonadherence was common and was more common in adolescents. Use of PBM databases to identify and intervene on patients with poor adherence may improve outcomes in pediatric IBD.
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