1 Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmarcy.
J Manag Care Spec Pharm. 2016 Nov;22(11):1311-1317. doi: 10.18553/jmcp.2016.22.11.1311.
The Centers for Medicare & Medicaid Services (CMS) adopted the proportion of days covered (PDC) calculation for use in their Five-Star Quality Rating System for Medicare Advantage and Prescription Drug Plans. This calculation uses the prescription adjudication date (i.e., date the prescription is billed to the benefits manager by a pharmacy) as a proxy for medication adherence. Adherence programs, such as automatic refill programs, have become commonplace in community pharmacy and have been identified by industry leaders as interfering with the ability to accurately measure adherence using PDC.
To evaluate the prescription pickup date instead of the currently used adjudication date to calculate PDC in the presence of a community pharmacy automatic refill program.
This study used a post-only quasi-experimental design with patients aged 65 years or older enrolled in automatic and manual refill programs in a 29-store community pharmacy chain during 2014. PDC was calculated using the prescription adjudication date and pickup date (i.e., date the patient brought the medication home) using pharmacy dispensing data for CMS adherence metrics medications, including statins, renin angiotensin aldosterone system antagonists (RASA), and noninsulin diabetes medications. Mann-Whitney U and effect size calculations evaluated differences in PDC between automatic and manual refill prescriptions for the adjudication date and pickup date, as well as the difference in PDC between adjudication and pickup date.
10,936 prescriptions were included with 21.9% enrolled in the automatic refill program. Mean (SD) adherence was 88.6 (17.6) and 86.4 (17.1) for automatic refills and 85.8 (19.0) and 85.0 (18.9) for manual refills, using the adjudication date and pickup date PDC, respectively. Significant difference existed between automatic and manual refill prescriptions using the adjudication date (P < 0.001) but not for the pickup date. The difference between adjudication and pickup date PDC ranged from 0% to 32.0% for automatic refills and 0% to 38.7% for manual refills. The difference between adjudication and pickup date PDC was significant when comparing automatic and manual refill prescriptions (P < 0.001).
The artificial inflation seen with adjudication date PDC indicates that the prescription pickup date is a more accurate reflection of patient medication taking. Automatic refills resulted in a less reliable PDC compared with manual refill prescriptions. Discussion about the continued use of the adjudication date to calculate PDC is needed.
The project described was supported by the Clinical and Translational Science Award (CTSA) program through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Lester is employed as a pharmacist in the pharmacy chain that participated in this study. The authors report no other relevant conflict of interest. Study concept and design were contributed primarily by Lester, along with Look and Chui. Lester took the lead in data collection, along with Look, and data interpretation, along with Look and Chui. The manuscript was written and revised primarily by Lester, along with Look and Chui.
医疗保险和医疗补助服务中心（CMS）采用了比例天数覆盖（PDC）计算方法，用于其医疗保险优势和处方药计划的五星级质量评级系统。该计算方法使用处方审定日期（即药房向福利经理提交处方的日期）作为药物依从性的代理指标。自动续药计划等已在社区药房中普遍存在，并已被行业领导者确定为干扰使用 PDC 准确测量依从性的能力。
评估在存在社区药房自动续药计划的情况下，使用处方取药日期而不是当前使用的审定日期来计算 PDC。
本研究使用了仅有后测的准实验设计，纳入了 2014 年在一家拥有 29 家门店的社区药房连锁店中参加自动和手动续药计划的 65 岁及以上患者。使用处方审定日期和取药日期（即患者将药物带回家的日期）来计算 PDC，取药日期使用药房配药数据，用于 CMS 依从性指标药物，包括他汀类药物、肾素-血管紧张素-醛固酮系统拮抗剂（RASA）和非胰岛素类糖尿病药物。使用 Mann-Whitney U 和效应量计算评估了自动和手动续药处方的 PDC 在审定日期和取药日期之间的差异，以及审定日期和取药日期之间的 PDC 差异。
纳入了 10936 张处方，其中 21.9%参加了自动续药计划。自动续药的平均（SD）依从率为 88.6（17.6）和 86.4（17.1），手动续药的依从率为 85.8（19.0）和 85.0（18.9），分别使用审定日期和取药日期 PDC。自动和手动续药处方的审定日期 PDC 之间存在显著差异（P < 0.001），但取药日期 PDC 则没有。自动续药的审定日期和取药日期 PDC 差异范围为 0%至 32.0%，手动续药的差异范围为 0%至 38.7%。比较自动和手动续药处方时，审定日期和取药日期 PDC 差异具有统计学意义（P < 0.001）。
审定日期 PDC 存在人为的膨胀，表明处方取药日期更能反映患者的药物服用情况。与手动续药处方相比，自动续药的 PDC 更不可靠。需要讨论是否继续使用审定日期来计算 PDC。
本研究由 NIH 国家转化医学中心（NCATS）的临床与转化科学奖（CTSA）项目资助。内容仅由作者负责，不一定代表 NIH 的官方观点。Lester 是参与本研究的连锁药房的药剂师。作者报告没有其他相关的利益冲突。研究概念和设计主要由 Lester 提出，同时还有 Look 和 Chui。Lester 主要负责数据收集，同时还有 Look，数据解释主要由 Look 和 Chui 负责。主要由 Lester 撰写和修订手稿，同时还有 Look 和 Chui。
