Johns Hopkins Home Care Group, Baltimore, Maryland.
Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee.
J Manag Care Spec Pharm. 2019 Oct;25(10):1073-1077. doi: 10.18553/jmcp.2019.25.10.1073.
Estimating medication adherence through the use of pharmacy claims-based adherence calculations such as medication possession ratio (MPR) and proportion of days covered (PDC) plays a significant role in specialty pharmacy practice. Although MPR and PDC are frequently used in clinical practice, calculation methodologies vary, making meaningful comparisons of adherence rates difficult. In addition, MPR and PDC are increasingly used by insurance companies, pharmacies, accrediting bodies, and drug manufacturers to demonstrate quality differences or clinical benefit across the specialty pharmacy industry. Therefore, recognizing the source and effect of calculation variability is necessary to fully understand reported adherence results. This article highlights the challenges in standardizing adherence methodologies, minimum methodology considerations that should be reported with MPR and PDC results, and key elements to consider when interpreting and applying adherence results. Further, recommendations are provided to promote a more consistent description of calculation methods and to aid pharmacies in adherence measure analysis, interpretation, and application to practice, with a focus on specialty pharmacy programs. A detailed description of methodology as outlined in this article must be provided to ensure reproducibility, external validation, and scientific rigor. In the absence of standardization, specialty pharmacies should be prudent in their use of adherence calculations as a clinical benchmarking tool or comparative quality indicator with outside organizations. Furthermore, specialty pharmacies should consider using current adherence measure calculations to identify and provide targeted interventions to patients with potential adherence problems and strive to better demonstrate ties between adherence measures and direct clinical and cost outcomes. DISCLOSURES: No outside funding supported the writing of this article. Anguiano is a speaker and research consultant for United Therapeutics. The other authors have nothing to disclose.
通过使用基于药房索赔的依从性计算方法（如药物持有率 [MPR] 和覆盖率 [PDC]）来估计药物依从性，在专业药房实践中起着重要作用。虽然 MPR 和 PDC 在临床实践中经常使用，但计算方法有所不同，使得难以对依从率进行有意义的比较。此外，保险公司、药房、认证机构和制药商越来越多地使用 MPR 和 PDC 来证明整个专业药房行业的质量差异或临床获益。因此，认识到计算变异性的来源和影响对于充分理解报告的依从性结果是必要的。本文强调了标准化依从性方法学的挑战、应报告 MPR 和 PDC 结果的最低方法学考虑因素，以及在解释和应用依从性结果时应考虑的关键要素。此外，还提出了建议，以促进更一致地描述计算方法，并帮助药房进行依从性衡量分析、解释和应用于实践，重点是专业药房计划。必须提供本文概述的方法学的详细描述，以确保可重复性、外部验证和科学严谨性。在缺乏标准化的情况下，专业药房应谨慎使用依从性计算作为临床基准工具或与外部组织的比较质量指标。此外，专业药房应考虑使用当前的依从性衡量计算方法来识别和为潜在依从性问题的患者提供针对性干预措施，并努力更好地证明依从性衡量标准与直接临床和成本结果之间的联系。披露：本文的撰写没有得到外部资金的支持。Anguiano 是 United Therapeutics 的演讲者和研究顾问。其他作者没有任何要披露的信息。
