Comparison of medication adherence measures derived from linked administrative data and associations with mortality using restricted cubic splines in heart failure patients
Purpose There is no gold standard method to calculate medication adherence using administrative drug data. We compared three common methods and their ability to predict subsequent mortality in patients with heart failure (HF). Methods Person‐linked population‐based datasets were used to identify 423...
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| Veröffentlicht in: | Pharmacoepidemiology and drug safety 2020-02, Vol.29 (2), p.208-218 |
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| creator | Qin, Xiwen Hung, Joseph Knuiman, Matthew W Briffa, Tom G Teng, Tiew‐Hwa Katherine Sanfilippo, Frank M |
| description | Purpose
There is no gold standard method to calculate medication adherence using administrative drug data. We compared three common methods and their ability to predict subsequent mortality in patients with heart failure (HF).
Methods
Person‐linked population‐based datasets were used to identify 4234 patients (56% male, mean age of 76), who survived 1 year (landmark period) following hospitalization for HF in Western Australia from 2003 to 2008. Adherence was estimated by the medication possession ratio (MPR), MPR modified (MPRm), and proportion of days covered (PDC) in patients dispensed a renin‐angiotensin system inhibitor (RASI) and/or β‐blocker within the landmark period. Adjusted Cox regression models that fitted restricted cubic splines (RCS) assessed the relationship between medication adherence and 1‐year all‐cause death postlandmark period.
Results
In the landmark period, 87% and 68% of the HF cohort were dispensed RASI and β‐blockers, respectively. Mean adherence estimates for RASI and β‐blockers were 90% and 79% for MPR, 96% and 86% for MPRm, and 82% and 73% for PDC, respectively. In RCS models, MPRm was not associated with subsequent 1‐year death in either the RASI or β‐blocker group, while MPR was independently associated with death in the RASI group only (P ≤ .01). However, PDC as a binary variable (PDC |
| doi_str_mv | 10.1002/pds.4939 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2342354735</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2350218361</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3499-ce0da37dbfde9bed1bb37ec71de72e902d5c8fd02c32076a3dba10653e7662793</originalsourceid><addsrcrecordid>eNp1kdtqFTEUhoMotlbBJ5CAN95MzWEy2bmU7REKCq3XQyZZ406dScYk07LfqQ_p2m1VKHiVZOXLt1b4CXnJ2SlnTLxdfDltjTSPyDFnxjRcKf34sFey2ajOHJFnpVwyhnemfUqOJDdqww0_JjfbNC82h5IiTSOdwQdna8CT9TvIEB1g0ZY1Q6EecrgCT8ecZjqF-BP31s8hhlIzvroC6m211Easl5JcuFUVeh3qjs4pVzuFuqdrCfEHRWPNwVWUuHUIjpYFndgmRLoDmysdbZiwMV1QA7GW5-TJaKcCL-7XE_L944eL7efm7OunL9t3Z42TLf7eAfNWaj-MHswAng-D1OA096AFGCa8cpvRM-GkYLqz0g-Ws05J0F0ntJEn5M2dd8np14pj9nMoDqbJRkhr6YVshVStlgrR1w_Qy7TmiNMhpZjgG9nxf0KXUykZxn7JYbZ533PWHxLsMcH-kCCir-6F64Bp_AX_RIZAcwdchwn2_xX1396f3wp_A6uhqh0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2350218361</pqid></control><display><type>article</type><title>Comparison of medication adherence measures derived from linked administrative data and associations with mortality using restricted cubic splines in heart failure patients</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Qin, Xiwen ; Hung, Joseph ; Knuiman, Matthew W ; Briffa, Tom G ; Teng, Tiew‐Hwa Katherine ; Sanfilippo, Frank M</creator><creatorcontrib>Qin, Xiwen ; Hung, Joseph ; Knuiman, Matthew W ; Briffa, Tom G ; Teng, Tiew‐Hwa Katherine ; Sanfilippo, Frank M</creatorcontrib><description>Purpose
There is no gold standard method to calculate medication adherence using administrative drug data. We compared three common methods and their ability to predict subsequent mortality in patients with heart failure (HF).
Methods
Person‐linked population‐based datasets were used to identify 4234 patients (56% male, mean age of 76), who survived 1 year (landmark period) following hospitalization for HF in Western Australia from 2003 to 2008. Adherence was estimated by the medication possession ratio (MPR), MPR modified (MPRm), and proportion of days covered (PDC) in patients dispensed a renin‐angiotensin system inhibitor (RASI) and/or β‐blocker within the landmark period. Adjusted Cox regression models that fitted restricted cubic splines (RCS) assessed the relationship between medication adherence and 1‐year all‐cause death postlandmark period.
Results
In the landmark period, 87% and 68% of the HF cohort were dispensed RASI and β‐blockers, respectively. Mean adherence estimates for RASI and β‐blockers were 90% and 79% for MPR, 96% and 86% for MPRm, and 82% and 73% for PDC, respectively. In RCS models, MPRm was not associated with subsequent 1‐year death in either the RASI or β‐blocker group, while MPR was independently associated with death in the RASI group only (P ≤ .01). However, PDC as a binary variable (PDC <80% or ≥80%) or continuous variable was independently associated with 1‐year death in both RASI and β‐blocker groups (all P ≤ .02).
Conclusion
Proportion of days covered calculated from administrative drug data provides a more conservative estimate of adherence than MPR or MPRm and was the most consistent predictor of subsequent mortality in an HF cohort using RCS analysis.</description><identifier>ISSN: 1053-8569</identifier><identifier>EISSN: 1099-1557</identifier><identifier>DOI: 10.1002/pds.4939</identifier><identifier>PMID: 31958191</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Inc</publisher><subject>administrative data ; Aged ; Aged, 80 and over ; analytical methods ; Angiotensin ; Cohort Studies ; Congestive heart failure ; Databases, Factual - trends ; Death ; evidence‐based medicines ; Female ; Heart failure ; Heart Failure - diagnosis ; Heart Failure - drug therapy ; Heart Failure - mortality ; Hospital Mortality - trends ; Humans ; Male ; Medication adherence ; Medication Adherence - psychology ; Mortality ; Patient compliance ; pharmacoepidemiology ; Regression analysis ; Renin ; restricted cubic splines ; Retrospective Studies</subject><ispartof>Pharmacoepidemiology and drug safety, 2020-02, Vol.29 (2), p.208-218</ispartof><rights>2020 John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3499-ce0da37dbfde9bed1bb37ec71de72e902d5c8fd02c32076a3dba10653e7662793</citedby><cites>FETCH-LOGICAL-c3499-ce0da37dbfde9bed1bb37ec71de72e902d5c8fd02c32076a3dba10653e7662793</cites><orcidid>0000-0003-3639-0787</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fpds.4939$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fpds.4939$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31958191$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Qin, Xiwen</creatorcontrib><creatorcontrib>Hung, Joseph</creatorcontrib><creatorcontrib>Knuiman, Matthew W</creatorcontrib><creatorcontrib>Briffa, Tom G</creatorcontrib><creatorcontrib>Teng, Tiew‐Hwa Katherine</creatorcontrib><creatorcontrib>Sanfilippo, Frank M</creatorcontrib><title>Comparison of medication adherence measures derived from linked administrative data and associations with mortality using restricted cubic splines in heart failure patients</title><title>Pharmacoepidemiology and drug safety</title><addtitle>Pharmacoepidemiol Drug Saf</addtitle><description>Purpose
There is no gold standard method to calculate medication adherence using administrative drug data. We compared three common methods and their ability to predict subsequent mortality in patients with heart failure (HF).
Methods
Person‐linked population‐based datasets were used to identify 4234 patients (56% male, mean age of 76), who survived 1 year (landmark period) following hospitalization for HF in Western Australia from 2003 to 2008. Adherence was estimated by the medication possession ratio (MPR), MPR modified (MPRm), and proportion of days covered (PDC) in patients dispensed a renin‐angiotensin system inhibitor (RASI) and/or β‐blocker within the landmark period. Adjusted Cox regression models that fitted restricted cubic splines (RCS) assessed the relationship between medication adherence and 1‐year all‐cause death postlandmark period.
Results
In the landmark period, 87% and 68% of the HF cohort were dispensed RASI and β‐blockers, respectively. Mean adherence estimates for RASI and β‐blockers were 90% and 79% for MPR, 96% and 86% for MPRm, and 82% and 73% for PDC, respectively. In RCS models, MPRm was not associated with subsequent 1‐year death in either the RASI or β‐blocker group, while MPR was independently associated with death in the RASI group only (P ≤ .01). However, PDC as a binary variable (PDC <80% or ≥80%) or continuous variable was independently associated with 1‐year death in both RASI and β‐blocker groups (all P ≤ .02).
Conclusion
Proportion of days covered calculated from administrative drug data provides a more conservative estimate of adherence than MPR or MPRm and was the most consistent predictor of subsequent mortality in an HF cohort using RCS analysis.</description><subject>administrative data</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>analytical methods</subject><subject>Angiotensin</subject><subject>Cohort Studies</subject><subject>Congestive heart failure</subject><subject>Databases, Factual - trends</subject><subject>Death</subject><subject>evidence‐based medicines</subject><subject>Female</subject><subject>Heart failure</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - mortality</subject><subject>Hospital Mortality - trends</subject><subject>Humans</subject><subject>Male</subject><subject>Medication adherence</subject><subject>Medication Adherence - psychology</subject><subject>Mortality</subject><subject>Patient compliance</subject><subject>pharmacoepidemiology</subject><subject>Regression analysis</subject><subject>Renin</subject><subject>restricted cubic splines</subject><subject>Retrospective Studies</subject><issn>1053-8569</issn><issn>1099-1557</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kdtqFTEUhoMotlbBJ5CAN95MzWEy2bmU7REKCq3XQyZZ406dScYk07LfqQ_p2m1VKHiVZOXLt1b4CXnJ2SlnTLxdfDltjTSPyDFnxjRcKf34sFey2ajOHJFnpVwyhnemfUqOJDdqww0_JjfbNC82h5IiTSOdwQdna8CT9TvIEB1g0ZY1Q6EecrgCT8ecZjqF-BP31s8hhlIzvroC6m211Easl5JcuFUVeh3qjs4pVzuFuqdrCfEHRWPNwVWUuHUIjpYFndgmRLoDmysdbZiwMV1QA7GW5-TJaKcCL-7XE_L944eL7efm7OunL9t3Z42TLf7eAfNWaj-MHswAng-D1OA096AFGCa8cpvRM-GkYLqz0g-Ws05J0F0ntJEn5M2dd8np14pj9nMoDqbJRkhr6YVshVStlgrR1w_Qy7TmiNMhpZjgG9nxf0KXUykZxn7JYbZ533PWHxLsMcH-kCCir-6F64Bp_AX_RIZAcwdchwn2_xX1396f3wp_A6uhqh0</recordid><startdate>202002</startdate><enddate>202002</enddate><creator>Qin, Xiwen</creator><creator>Hung, Joseph</creator><creator>Knuiman, Matthew W</creator><creator>Briffa, Tom G</creator><creator>Teng, Tiew‐Hwa Katherine</creator><creator>Sanfilippo, Frank M</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3639-0787</orcidid></search><sort><creationdate>202002</creationdate><title>Comparison of medication adherence measures derived from linked administrative data and associations with mortality using restricted cubic splines in heart failure patients</title><author>Qin, Xiwen ; Hung, Joseph ; Knuiman, Matthew W ; Briffa, Tom G ; Teng, Tiew‐Hwa Katherine ; Sanfilippo, Frank M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3499-ce0da37dbfde9bed1bb37ec71de72e902d5c8fd02c32076a3dba10653e7662793</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>administrative data</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>analytical methods</topic><topic>Angiotensin</topic><topic>Cohort Studies</topic><topic>Congestive heart failure</topic><topic>Databases, Factual - trends</topic><topic>Death</topic><topic>evidence‐based medicines</topic><topic>Female</topic><topic>Heart failure</topic><topic>Heart Failure - diagnosis</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - mortality</topic><topic>Hospital Mortality - trends</topic><topic>Humans</topic><topic>Male</topic><topic>Medication adherence</topic><topic>Medication Adherence - psychology</topic><topic>Mortality</topic><topic>Patient compliance</topic><topic>pharmacoepidemiology</topic><topic>Regression analysis</topic><topic>Renin</topic><topic>restricted cubic splines</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Qin, Xiwen</creatorcontrib><creatorcontrib>Hung, Joseph</creatorcontrib><creatorcontrib>Knuiman, Matthew W</creatorcontrib><creatorcontrib>Briffa, Tom G</creatorcontrib><creatorcontrib>Teng, Tiew‐Hwa Katherine</creatorcontrib><creatorcontrib>Sanfilippo, Frank M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pharmacoepidemiology and drug safety</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Qin, Xiwen</au><au>Hung, Joseph</au><au>Knuiman, Matthew W</au><au>Briffa, Tom G</au><au>Teng, Tiew‐Hwa Katherine</au><au>Sanfilippo, Frank M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of medication adherence measures derived from linked administrative data and associations with mortality using restricted cubic splines in heart failure patients</atitle><jtitle>Pharmacoepidemiology and drug safety</jtitle><addtitle>Pharmacoepidemiol Drug Saf</addtitle><date>2020-02</date><risdate>2020</risdate><volume>29</volume><issue>2</issue><spage>208</spage><epage>218</epage><pages>208-218</pages><issn>1053-8569</issn><eissn>1099-1557</eissn><abstract>Purpose
There is no gold standard method to calculate medication adherence using administrative drug data. We compared three common methods and their ability to predict subsequent mortality in patients with heart failure (HF).
Methods
Person‐linked population‐based datasets were used to identify 4234 patients (56% male, mean age of 76), who survived 1 year (landmark period) following hospitalization for HF in Western Australia from 2003 to 2008. Adherence was estimated by the medication possession ratio (MPR), MPR modified (MPRm), and proportion of days covered (PDC) in patients dispensed a renin‐angiotensin system inhibitor (RASI) and/or β‐blocker within the landmark period. Adjusted Cox regression models that fitted restricted cubic splines (RCS) assessed the relationship between medication adherence and 1‐year all‐cause death postlandmark period.
Results
In the landmark period, 87% and 68% of the HF cohort were dispensed RASI and β‐blockers, respectively. Mean adherence estimates for RASI and β‐blockers were 90% and 79% for MPR, 96% and 86% for MPRm, and 82% and 73% for PDC, respectively. In RCS models, MPRm was not associated with subsequent 1‐year death in either the RASI or β‐blocker group, while MPR was independently associated with death in the RASI group only (P ≤ .01). However, PDC as a binary variable (PDC <80% or ≥80%) or continuous variable was independently associated with 1‐year death in both RASI and β‐blocker groups (all P ≤ .02).
Conclusion
Proportion of days covered calculated from administrative drug data provides a more conservative estimate of adherence than MPR or MPRm and was the most consistent predictor of subsequent mortality in an HF cohort using RCS analysis.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Inc</pub><pmid>31958191</pmid><doi>10.1002/pds.4939</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-3639-0787</orcidid></addata></record> |
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| ispartof | Pharmacoepidemiology and drug safety, 2020-02, Vol.29 (2), p.208-218 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | administrative data Aged Aged, 80 and over analytical methods Angiotensin Cohort Studies Congestive heart failure Databases, Factual - trends Death evidence‐based medicines Female Heart failure Heart Failure - diagnosis Heart Failure - drug therapy Heart Failure - mortality Hospital Mortality - trends Humans Male Medication adherence Medication Adherence - psychology Mortality Patient compliance pharmacoepidemiology Regression analysis Renin restricted cubic splines Retrospective Studies |
| title | Comparison of medication adherence measures derived from linked administrative data and associations with mortality using restricted cubic splines in heart failure patients |
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