Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.
Br J Clin Pharmacol. 2021 Mar;87(3):1089-1097. doi: 10.1111/bcp.14468. Epub 2020 Jul 23.
Prescribed daily dose (PDD), the number of doses prescribed to be taken per day, is used to calculate medication adherence using pharmacy claims data. PDD can be substituted by (i) one dose per day (1DD), (ii) an estimate based on the 75th percentile of days taken by patients to refill a script (PDD ) or (iii) the World Health Organization's defined daily dose (DDD). We aimed to compare these approaches for estimating the duration covered by medications and whether this affects calculated 1-year adherence to antihypertensive medications post-stroke.
We conducted a retrospective review of prospective cohort data from the ongoing Australian Stroke Clinical Registry linked with pharmacy claims data. Adherence was calculated as the proportion of days covered (PDC) for 1DD, PDD and DDD. Differences were assessed using Wilcoxon rank-sum tests.
Among 12 628 eligible patients with stroke, 10 057 (80%) were prescribed antihypertensive medications in the year after hospital discharge (78.2% aged ≥65 years, 45.2% female). Overall, the 75th percentile of patient time until next medication refill was 39 days. The greatest variations in dose regimens, estimated using person- and dose-level refill times, were for beta blockers (11.4% taking two tablets/day). There were comparable levels of adherence between 1DD and the PDD (median PDC 91.0% vs 91.2%; P = 0.70), but adherence was slightly higher using DDD (92.3%; both P < 0.001). However, this would represent a clinically nonsignificant difference.
Adherence to antihypertensive medications shows similar estimates across standard measures of dosage in patients during the first year after an acute stroke.
规定的每日剂量（PDD），即每天规定服用的剂量数，用于使用药房索赔数据计算药物依从性。PDD 可以用以下方法替代：（i）每天一次剂量（1DD），（ii）根据患者补充处方的天数的第 75 百分位数（PDD）的估计值，或（iii）世界卫生组织定义的日剂量（DDD）。我们旨在比较这些方法来估计药物覆盖的持续时间，以及这是否会影响中风后 1 年内抗高血压药物的计算依从性。
我们对正在进行的澳大利亚中风临床登记处的前瞻性队列数据进行了回顾性审查，并与药房索赔数据进行了关联。依从性计算为 1DD、PDD 和 DDD 的天数覆盖率（PDC）的比例。使用 Wilcoxon 秩和检验评估差异。
在 12628 名符合条件的中风患者中，有 10057 名（80%）在出院后一年内开了抗高血压药物（78.2%年龄≥65 岁，45.2%为女性）。总体而言，患者下次药物补充前的时间的第 75 百分位数为 39 天。使用个人和剂量水平的补充时间来估计，药物剂量方案的变化最大，β受体阻滞剂（11.4%每天服用两片）的变化最大。1DD 和 PDD 的依从性相当（中位数 PDC 分别为 91.0%和 91.2%；P = 0.70），但使用 DDD 时的依从性略高（92.3%；均 P < 0.001）。然而，这只是一个临床上的非显著差异。
在急性中风后第一年的患者中，抗高血压药物的依从性在标准剂量测量方法中表现出相似的估计值。
