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A method for calculating adherence to polypharmacy from dispensing data records
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift)
 
ID 2361439
Author(s) Arnet, Isabelle; Abraham, Ivo; Messerli, Markus; Hersberger, Kurt E
Author(s) at UniBasel Arnet, Isabelle
Messerli, Markus
Hersberger, Kurt
Year 2014
Title A method for calculating adherence to polypharmacy from dispensing data records
Journal International journal of clinical pharmacy
Volume 36
Number 1
Pages / Article-Number 192-201
Keywords Adherence, Compliance, Daily polypharmacy possession ratio, Medication possession ratio, Pharmacy claims, Polypharmacy, Refill data
Abstract

Background Several measures for calculating adherence to one medication from dispensing data records have been proposed, but the nomenclature is inconsistent and computations vary. The same measures, like the medication possession ratio (MPR), have been used for multiple medication regimens, and have tended to over- or under-estimate adherence rates. Objective To demonstrate the impact of varying elements in MPR to a single medication regimen; to define standards for the estimation of adherence to polypharmacy; to propose a new method for calculating adherence to polypharmacy; to face validate it. Setting Face validity of the proposed method. Method Variations in the MPR formula were simulated. Standards for the estimation of adherence to polypharmacy were defined. A new method to calculate adherence to polypharmacy was established. Its face validity with three illustrative cases obtained from a pharmacy refill database was assessed. Main outcome measure Adherence rate to polypharmacy from refill data records. Results MPR to a single medication is operationalized in the numerator and denominator and is influenced by the parameters like observation period, medication gaps, overlap. For polypharmacy, an average MPR is commonly used, which is not accounting for the specificity of multiple medications, and hence overestimating adherence rate. We propose the daily polypharmacy possession ratio (DPPR) as an index of adherence to polypharmacy. It estimates the proportion of time a patient had medication available for use by considering the presence or absence of multiple medications on each day in the observation period. We calculated possession rates from refill histories over 31†months (January 1, 2011-July 31, 2013) for three illustrative patients. The average MPR estimates were 80†% for a patient with 6 medications/20 refill dates, 90†% for a patient with 4 medications/11 refill dates, and 89†% for a patient with 3 medications/17 refill dates. The corresponding DPPRs were 75, 88 and 99†%, indicating overestimations by 5 and 2†%, and underestimation by 10†%, respectively. Conclusion The DPPR accounts for the specificity of polypharmacy including number of medications, medication switching, duplication, overlapping. Research is needed to further confirm the validity of this new index.

Publisher Springer
ISSN/ISBN 2210-7703
edoc-URL http://edoc.unibas.ch/dok/A6223424
Full Text on edoc No
Digital Object Identifier DOI 10.1007/s11096-013-9891-8
PubMed ID http://www.ncbi.nlm.nih.gov/pubmed/24293284
ISI-Number WOS:000329832500026
Document type (ISI) Journal Article
 
   

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