Curtis Jeffrey R, Westfall Andrew O, Allison Jeroan, Freeman Allison, Kovac Stacey H, Saag Kenneth G
Division of Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
Pharmacoepidemiol Drug Saf. 2006 Oct;15(10):710-8. doi: 10.1002/pds.1226.
Pharmacy and linked claims databases are commonly used to determine medication receipt as a measure of quality of care. However, these data sources have not been previously compared with self-reported data for receipt of medications used for glucocorticoid-induced osteoporosis (GIOP).
Using databases from a national managed care organization (MCO), we identified 6282 chronic glucocorticoid users (60+ days in 18 months). We compared self-reported current use of alendronate, risedronate, calcitonin, and raloxifene (reference standard) to different intervals of preceding pharmacy data to determine agreement, sensitivity, specificity, and positive and negative predictive values of the pharmacy data.
Survey respondents (n = 2363) were mean +/- SD age 53 +/- 14 years old, 70% women, and 78% Caucasian. Agreement between self-reported and pharmacy data ranged from Kappa = 0.64 (95%CI 0.53-0.75) (calcitonin) to 0.80 (0.76-0.84) (alendronate). The positive predictive value of a filled prescription in the pharmacy database in the prior 6 months exceeded 90% compared to the reference standard of self-reported current bisphosphonate use. However, the 6-month interval of pharmacy data failed to capture >25% of self-reported current bisphosphonate users. The optimal interval of pharmacy data to distinguish between current and past bisphosphonate users was 120-180 days.
Among chronic glucocorticoid users enrolled in managed care, underreporting of current osteoporosis medication use was uncommon, and agreement between self-report and pharmacy data was high. Use of pharmacy data alone is unlikely to underestimate quality of osteoporosis care, but different intervals of pharmacy data have important implications on the ability to identify current users of osteoporosis medications.
药房和相关索赔数据库通常用于确定药物的使用情况，以此作为医疗质量的一项衡量指标。然而，此前尚未将这些数据源与糖皮质激素性骨质疏松症（GIOP）所用药物使用情况的自我报告数据进行比较。
利用一家全国性管理式医疗组织（MCO）的数据库，我们识别出6282名长期使用糖皮质激素的患者（18个月内使用60天以上）。我们将阿仑膦酸钠、利塞膦酸钠、降钙素和雷洛昔芬的自我报告当前使用情况（参考标准）与之前不同时间段的药房数据进行比较，以确定药房数据的一致性、敏感性、特异性以及阳性和阴性预测值。
调查对象（n = 2363）的平均年龄为53±14岁，标准差为±14岁，70%为女性，78%为白种人。自我报告数据与药房数据之间的一致性范围为Kappa值= 0.64（95%置信区间0.53 - 0.75）（降钙素）至0.80（0.76 - 0.84）（阿仑膦酸钠）。与自我报告当前双膦酸盐使用情况的参考标准相比，药房数据库中前6个月有用药记录的阳性预测值超过90%。然而，药房数据的6个月时间段未能涵盖超过25%的自我报告当前双膦酸盐使用者。区分当前和过去双膦酸盐使用者的药房数据最佳时间段为120 - 180天。
在参加管理式医疗的长期使用糖皮质激素的患者中，当前骨质疏松症药物使用情况漏报的情况并不常见，自我报告数据与药房数据之间的一致性较高。仅使用药房数据不太可能低估骨质疏松症的治疗质量，但不同时间段的药房数据对识别当前骨质疏松症药物使用者的能力有重要影响。
