通过链接电子健康记录和药房数据来估计对心力衰竭药物的坚持
Saul Blecker1,2, Yunan Zhao3, Xiyue Li3
1Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA. saul.blecker@nyulangone.org.
Journal of general internal medicine
|November 25, 2024
概括
利用心力衰竭患者的链接电子健康记录和药房数据,可以更准确地衡量药物坚持. 这种方法可以识别从来没有填写处方的患者,与仅限于药房的数据不同,导致遵守估计较低.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 医疗信息学 医疗信息学
背景情况:
- 药物不服药在诸如心力衰竭等慢性疾病中普遍存在,影响治疗疗效.
- 覆盖日数比例 (PDC) 是一个常见的遵守指标,通常使用药房或保险索赔来计算.
- 仅使用药房数据的传统PDC计算可能无法捕捉所有坚持行为,因为缺少处方信息.
研究的目的:
- 提出使用集成电子健康记录 (EHR) 和药房数据计算PDC的方法.
- 在心力衰竭患者中,比较来自链接的EHR-药房数据与药房数据的PDC坚持估计.
主要方法:
- 一项回顾性队列研究分析了成年心力衰竭患者的指导指导医学治疗 (GDMT).
- 使用链接的EHR-药房数据计算PDC,将坚持定义为与药物持有相对于有效处方持续时间的几天.
- 第二次计算仅使用药房数据,根据持续填充的几天内持有药物的PDC定义PDC.
主要成果:
- 在33,212名心力衰竭患者中,6.7%的人从未填写过GDMT处方,仅在药房PDC计算中错过了.
- 链接的EHR-药房数据为PDC评估提供了稍长的观察期 (164.7天而不是163.4天).
- 使用链接的EHR-药房数据 (78.5%PDC) 的依从估计较低,而不是仅药房数据 (90.6%PDC).
结论:
- 集成的EHR-药房数据有效地识别了未能填写初始处方的患者.
- 使用链接的EHR-药房数据进行依从性评估,产生的PDC平均值低于仅药房的方法.
- 这种增强的方法为在常规临床护理中对药物坚持提供了更全面的理解.
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