Shafrin Jason, Bognar Katalin, Everson Katie, Brauer Michelle, Lakdawalla Darius N, Forma Felicia M
Policy and Economics, Precision Health Economics, Los Angeles, CA, USA,
Policy and Economics, Precision Health Economics, Boston, MA, USA.
Clinicoecon Outcomes Res. 2018 Oct 2;10:573-585. doi: 10.2147/CEOR.S175877. eCollection 2018.
New digital technologies offer providers the promise of more accurately tracking patients' medication adherence. It is unclear, however, whether access to such information will affect provider treatment decisions in the real world.
Using prescriber-reported information on patient non-compliance from health insurance claims data between 2008 and 2014, we examined whether prescribers' knowledge of non-compliance was associated with different prescribing patterns for patients with serious mental illness (SMI). We examined patients who initiated an oral atypical antipsychotic, but were later objectively non-adherent to this treatment, defined as proportion of days covered (PDC) <0.8. We examined how a physician's awareness of patient non-compliance (ICD-9 diagnosis code: V15.81) was correlated with the physician's real-world treatment decisions for that patient. Treatment decisions studied included the share of patients who increased antipsychotic dose, augmented treatment, switched their antipsychotic, or used a long-acting injectable (LAI).
Among the 286,249 patients with SMI who initiated an antipsychotic and had PDC <0.8, 4,033 (1.4%) had documented non-compliance. When prescribers documented non-compliance, patients were more likely to be switched to another antipsychotic (32.8% vs 24.7%, <0.001), have their dose increased (24.4% vs 22.1%, =0.004), or receive an LAI (0.09% vs 0.04%, =0.008), but were less likely to have augmented therapy with another antipsychotic (1.1% vs 1.3%, =0.035) than patients without documented non-compliance.
Among SMI patients with documented non-compliance, the frequency of dose, medication switches, and LAI use were higher and augmentation was lower compared to patients without documented non-compliance. Access to adherence information may help prescribers more rapidly switch ineffective medications as well as avoid unnecessary medication augmentation.
新的数字技术有望使医疗服务提供者更准确地跟踪患者的药物依从性。然而，在现实世界中，获取此类信息是否会影响医疗服务提供者的治疗决策尚不清楚。
利用2008年至2014年医疗保险理赔数据中开处方者报告的患者不依从信息，我们研究了开处方者对不依从的了解是否与严重精神疾病（SMI）患者的不同处方模式相关。我们研究了开始使用口服非典型抗精神病药物但后来客观上未坚持该治疗的患者，将其定义为覆盖天数比例（PDC）<0.8。我们研究了医生对患者不依从的认知（ICD-9诊断代码：V15.81）与医生针对该患者的现实世界治疗决策之间的相关性。研究的治疗决策包括增加抗精神病药物剂量、强化治疗、更换抗精神病药物或使用长效注射剂（LAI）的患者比例。
在286,249例开始使用抗精神病药物且PDC<0.8的SMI患者中，有4,033例（1.4%）有记录的不依从情况。当开处方者记录不依从情况时，患者更有可能更换为另一种抗精神病药物（32.8%对24.7%，<0.001）、增加剂量（24.4%对22.1%，=0.004）或接受LAI（0.09%对0.04%，=0.008），但与没有记录不依从情况的患者相比，接受另一种抗精神病药物强化治疗的可能性较小（1.1%对1.3%，=0.035）。
在有记录不依从情况的SMI患者中与没有记录不依从情况的患者相比，剂量调整、药物更换和LAI使用的频率更高，强化治疗的频率更低。获取依从性信息可能有助于开处方者更快地更换无效药物，并避免不必要的药物强化治疗。
