Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec City, QC, Canada; Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada.
Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec City, QC, Canada; Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada.
Res Social Adm Pharm. 2019 Jun;15(6):738-743. doi: 10.1016/j.sapharm.2018.09.005. Epub 2018 Sep 14.
The use of prescription claims data to measure adherence to diabetes treatment is very common in research. However, there is no clear evidence regarding the accuracy of the methods used to assess adherence to multi-drug treatments for the many patients using multiple antidiabetic drugs.
To assess the validity of prescription claims-based adherence measures in the context of multiple oral antidiabetic drug treatment.
A cohort of patients who began their antidiabetic drug treatment with at least two oral antidiabetic drugs (new users) was created using Quebec medico-administrative data. Four different prescription claims-based adherence measures were assessed: proportion of days covered (PDC) by at least one class of drugs, mean PDC, PDC by all classes and daily polypharmacy possession ratio (DPPR). All-cause and diabetes-related hospitalizations were the validation criteria. To assess the validity of the measures, receiver operating characteristic (ROC) curves were plotted for each measure and each criterion.
A total of 5982 individuals were included. The areas under the ROC curves for the PDC by at least one class of drugs, the mean PDC, the PDC by all classes of drugs and the DPPR were respectively 0.54 (95% CI: 0.52-0.56), 0.51 (0.49-0.53), 0.50 (0.48-0.52) and 0.51 (0.49-0.53) with all-cause hospitalization as criterion and 0.55 (0.53-0.57), 0.53 (0.51-0.55), 0.51 (0.49-0.53) and 0.53 (0.51-0.55) using diabetes-related hospitalization as criterion.
The results suggest that all measures have poor validity in predicting hospitalizations thus raising concerns about their utility in the assessment of adherence to multi-drug treatment. Future research should assess the capacity of these measures to predict other outcomes more closely related to medication adherence.
在研究中，使用处方索赔数据来衡量糖尿病治疗的依从性非常普遍。然而，对于许多使用多种抗糖尿病药物的患者，使用多种药物治疗时，评估依从性的方法的准确性尚无明确证据。
评估基于处方索赔的依从性测量方法在多种口服抗糖尿病药物治疗中的有效性。
使用魁北克医疗管理数据创建了一个至少使用两种口服抗糖尿病药物开始治疗的糖尿病患者队列（新使用者）。评估了四种不同的基于处方索赔的依从性测量方法：至少一类药物的天数覆盖率（PDC）、平均 PDC、所有类别的 PDC 和每日多药占有比（DPPR）。全因和糖尿病相关住院是验证标准。为了评估这些措施的有效性，为每种措施和每种标准绘制了接收者操作特征（ROC）曲线。
共纳入 5982 人。至少一类药物的 PDC、平均 PDC、所有类别药物的 PDC 和 DPPR 的 ROC 曲线下面积分别为 0.54（95%CI：0.52-0.56）、0.51（0.49-0.53）、0.50（0.48-0.52）和 0.51（0.49-0.53），全因住院为标准，0.55（0.53-0.57）、0.53（0.51-0.55）、0.51（0.49-0.53）和 0.53（0.51-0.55），糖尿病相关住院为标准。
结果表明，所有措施在预测住院方面的有效性都很差，这引起了人们对其在评估多药治疗依从性方面的实用性的关注。未来的研究应评估这些措施预测与药物依从性更密切相关的其他结果的能力。
