Dalli Lachlan L, Kilkenny Monique F, Arnet Isabelle, Sanfilippo Frank M, Cummings Doyle M, Kapral Moira K, Kim Joosup, Cameron Jan, Yap Kevin Y, Greenland Melanie, Cadilhac Dominique A
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria.
Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia.
Br J Clin Pharmacol. 2022 Oct;88(10):4427-4442. doi: 10.1111/bcp.15391. Epub 2022 May 22.
Although medication adherence is commonly measured in electronic datasets using the proportion of days covered (PDC), no standardized approach is used to calculate and report this measure. We conducted a scoping review to understand the approaches taken to calculate and report the PDC for cardiovascular medicines to develop improved guidance for researchers using this measure. After prespecifying methods in a registered protocol, we searched Ovid Medline, Embase, Scopus, CINAHL Plus and grey literature (1 July 2012 to 14 December 2020) for articles containing the terms "proportion of days covered" and "cardiovascular medicine", or synonyms and subject headings. Of the 523 articles identified, 316 were reviewed in full and 76 were included (93% observational studies; 47% from the USA; 2 grey literature articles). In 45 articles (59%), the PDC was measured from the first dispensing/claim date. Good adherence was defined as 80% PDC in 61 articles, 56% of which contained a rationale for selecting this threshold. The following parameters, important for deriving the PDC, were often not reported/unclear: switching (53%), early refills (45%), in-hospital supplies (45%), presupply (28%) and survival (7%). Of the 46 articles where dosing information was unavailable, 59% reported how doses were imputed. To improve the transparent and systematic reporting of the PDC, we propose the TEN-SPIDERS tool, covering the following PDC parameters: Threshold, Eligibility criteria, Numerator and denominator, Survival, Presupply, In-hospital supplies, Dosing, Early Refills, and Switching. Use of this tool will standardize reporting of the PDC to facilitate reliable comparisons of medication adherence estimates between studies.
尽管在电子数据集中通常使用覆盖天数比例（PDC）来衡量药物依从性，但在计算和报告该指标时并未采用标准化方法。我们进行了一项范围综述，以了解计算和报告心血管药物PDC的方法，从而为使用该指标的研究人员制定更好的指南。在预先指定的注册方案中确定方法后，我们在Ovid Medline、Embase、Scopus、CINAHL Plus和灰色文献（2012年7月1日至2020年12月14日）中搜索包含“覆盖天数比例”和“心血管药物”或同义词及主题词的文章。在识别出的523篇文章中，316篇进行了全文审查，76篇被纳入（93%为观察性研究；47%来自美国；2篇灰色文献文章）。在45篇文章（59%）中，PDC是从首次配药/报销日期开始测量的。61篇文章将良好依从性定义为PDC达到80%，其中56%包含选择该阈值的理由。对于推导PDC很重要的以下参数经常未报告/不清楚：换药（53%）、提前 refill（45%）、住院用药（45%）、预用药（28%）和生存情况（7%）。在46篇无法获取给药信息的文章中，59%报告了如何估算剂量。为了改善PDC的透明和系统报告，我们提出了TEN - SPIDERS工具，涵盖以下PDC参数：阈值、纳入标准、分子和分母、生存情况、预用药、住院用药、给药、提前 refill和换药。使用该工具将使PDC的报告标准化，以便于在不同研究之间对药物依从性估计值进行可靠比较。
