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Comparison of Pharmacy Refill Data With Chemical Adherence Testing in Assessing Medication Nonadherence in a Safety
David Osula1, Bryan Wu1, Kevin Schesing1
1Department of Internal Medicine Parkland Health & Hospital System Dallas TX.
Journal of the American Heart Association
|October 4, 2022
Summary
Pharmacy fill data, measured by proportion of days covered (PDC), effectively identifies nonadherence to ACE inhibitors/ARBs and statins. However, PDC shows limited accuracy for other antihypertensives and has low positive predictive value overall.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Health Outcomes Research
Background:
- Pharmacy fill data are commonly used to assess medication nonadherence.
- Previous research has not directly compared pharmacy fill data accuracy with direct drug level measurements or chemical adherence testing (CAT).
Purpose of the Study:
- To compare the accuracy of pharmacy fill data (proportion of days covered, PDC) against chemical adherence testing (CAT) for cardiovascular medications in patients with uncontrolled hypertension.
Main Methods:
- A cross-sectional study was conducted in patients with uncontrolled hypertension.
- Plasma drug levels were measured using liquid chromatography-mass spectrometry.
- Pharmacy fill data (PDC) were calculated and compared with CAT results for various cardiovascular drug classes.
Main Results:
- 17% of patients were nonadherent to antihypertensives and 37% to statins by CAT.
- PDC accurately identified nonadherence for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE inhibitors/ARBs) and statins (P<0.05).
- PDC demonstrated limited accuracy for calcium channel blockers, beta blockers, and thiazide diuretics, with low positive predictive values (11-45%) across drug classes.
Conclusions:
- Proportion of days covered (PDC) is a useful tool for detecting nonadherence to ACE inhibitors/ARBs and statins.
- PDC has limited utility for assessing adherence to other common antihypertensive classes due to low positive predictive value.
- Chemical adherence testing (CAT) remains a more comprehensive method for evaluating medication adherence across diverse drug classes.
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