Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Am Heart J. 2020 Oct;228:36-43. doi: 10.1016/j.ahj.2020.06.012. Epub 2020 Jun 24.
Less than half of patients with cardiometabolic disease consistently take prescribed medications. While health insurers and some delivery organizations use claims to measure adherence, most clinicians do not have access during routine interactions. Self-reported scales exist, but their practical utility is often limited by length or cost. By contrast, the accuracy of a new 3-item self-reported measure has been demonstrated in individuals with HIV. We evaluated its concordance with claims-based adherence measures in cardiometabolic disease.
We used data from a recently-completed pragmatic trial of patients with cardiometabolic conditions. After 12 months of follow-up, intervention subjects were mailed a survey with the 3-item measure that queries about medication use in the prior 30 days. Responses were linearly transformed and averaged. Adherence was also measured in claims in month 12 and months 1-12 of the trial using proportion of days covered (PDC) metrics. We compared validation metrics for non-adherence for self-report (average <0.80) compared with claims (PDC <0.80).
Of 459 patients returning the survey (response rate: 43.5%), 50.1% were non-adherent in claims in month 12 while 20.9% were non-adherent based on the survey. Specificity of the 3-item metric for non-adherence was high (month 12: 0.83). Sensitivity was relatively poor (month 12: 0.25). Month 12 positive and negative predictive values were 0.59 and 0.52, respectively.
A 3-item self-reported measure has high specificity but poor sensitivity for non-adherence versus claims in cardiometabolic disease. Despite this, the tool could help target those needing adherence support, particularly in the absence of claims data.
只有不到一半的心血管代谢疾病患者能够持续服用规定的药物。虽然健康保险公司和一些医疗机构使用理赔数据来衡量患者的用药依从性，但大多数临床医生在日常医患互动中无法获取这一信息。目前存在一些自我报告的量表，但由于篇幅或费用问题，其实际应用受到限制。相比之下，一种新的三项目自我报告量表已在 HIV 患者中得到验证。我们评估了其在心血管代谢疾病患者中的应用，与理赔数据衡量的用药依从性的一致性。
我们使用了一项刚刚完成的心血管代谢疾病患者实用临床试验的数据。在 12 个月的随访后，干预组患者会收到一份调查问卷，其中包括三项目量表，询问患者在过去 30 天内的用药情况。回答将被线性转换并取平均值。在第 12 个月和试验的第 1-12 个月，我们使用覆盖天数比例（PDC）指标在理赔数据中测量依从性。我们比较了自我报告（平均值<0.80）和理赔（PDC<0.80）数据中用于非依从性的验证指标。
在收到调查的 459 名患者中（回复率：43.5%），50.1%的患者在第 12 个月的理赔数据中显示为不依从，20.9%的患者根据调查显示为不依从。三项目量表在判断不依从方面具有较高的特异性（第 12 个月：0.83）。敏感性相对较差（第 12 个月：0.25）。第 12 个月的阳性预测值和阴性预测值分别为 0.59 和 0.52。
与心血管代谢疾病的理赔数据相比，三项目自我报告量表在判断不依从方面具有较高的特异性，但敏感性较低。尽管如此，该工具仍可帮助确定需要用药依从性支持的患者，尤其是在缺乏理赔数据的情况下。
