University of Basel, Department of Pharmaceutical Sciences, Klingelbergstrasse 50, 4056, Basel, Switzerland.
24 Stunden Apotheke Basel AG, Petersgraben 3, 4001, Basel, Switzerland.
Res Social Adm Pharm. 2024 Dec;20(12 Pt A):1096-1101. doi: 10.1016/j.sapharm.2024.08.090. Epub 2024 Aug 26.
Direct oral anticoagulants are the preferred treatment for stroke patients with atrial fibrillation. Pharmacy dispensing data represent a practical method to identify suboptimal medication adherence.
This study investigates whether pharmacy dispensing data are indicative of real-life adherence behavior, using data from 130 patients in the MAAESTRO study (2018-2022) in Basel, Switzerland.
This secondary data analysis of the MAAESTRO study (Dietrich, 2024) included patients with electronic monitoring (EM) and dispensing data for 12 months. Patients with at least two refills were included in the analysis. We categorized refill series into three adherence patterns using the Delta T method (Baumgartner, 2022): all refills on time, erratic refills, end-gaps ≥10 days. EM-adherence was assessed through "taking adherence" and "missing days" (24h without intake). We analyzed: i) all dispensing data ("all refills"); ii) all data independently of the MAAESTRO phase ("all phases"); iii) the last two dispensing data ("last"), and iv) EM data from the MAAESTRO phase that match the date of the last refill ("matched"). Associations between refill patterns and adherence were examined using Spearman correlation and Fisher's exact test.
Data analyzed from 50 patients (mean age 76.4 ± 9.1 years, 56.0 % male) included 252 refills with a median of 4 refills per patient. Refill patterns were: all refills on time (40.0 %), erratic refills (36.0 %), and end-gaps >10 days (24.0 %). Mean taking adherence was 89.3 ± 13.7 %. EM data revealed missing days in 82.0 % of patients, with 61.0 % having irregular refill patterns. Matched taking adherence was moderately associated with Delta T over all refills (p = 0.034) and the last refill (p = 0.013).
Dispensing data processed with the Delta T method correlate moderately with EM data. The Delta T value for the last two refills shows promise for estimating irregular adherence, suggesting potential for targeted interventions in pharmacy practice.
直接口服抗凝剂是治疗伴有心房颤动的脑卒中患者的首选治疗方法。药房配药数据代表了一种识别药物依从性不佳的实用方法。
本研究使用来自瑞士巴塞尔 MAAESTRO 研究（2018-2022 年）的 130 名患者的数据，调查药房配药数据是否能反映真实生活中的用药依从性。
对 MAAESTRO 研究（Dietrich，2024 年）的二次数据分析纳入了电子监测（EM）和 12 个月配药数据的患者。至少有两次配药的患者纳入分析。我们使用 Delta T 方法（Baumgartner，2022 年）将续药系列分为三种依从模式：所有续药均按时、不规则续药、结束期缺口≥10 天。通过“用药依从性”和“缺失天数”（24 小时无摄入）评估 EM 依从性。我们分析了：i）所有配药数据（“所有续药”）；ii）独立于 MAAESTRO 阶段的所有数据（“所有阶段”）；iii）最后两次配药数据（“最后”）和 iv）与最后一次配药日期匹配的 MAAESTRO 阶段的 EM 数据（“匹配”）。使用 Spearman 相关系数和 Fisher 确切检验分析续药模式与依从性之间的关联。
对 50 名患者（平均年龄 76.4±9.1 岁，56.0%为男性）的数据进行了分析，共包括 252 次续药，每位患者的中位数为 4 次。续药模式为：所有续药均按时（40.0%）、不规则续药（36.0%）和结束期缺口>10 天（24.0%）。平均用药依从性为 89.3±13.7%。EM 数据显示，82.0%的患者存在缺失天数，61.0%的患者存在不规则续药模式。所有续药和最后一次续药的匹配用药依从性与 Delta T 呈中度相关（p=0.034 和 p=0.013）。
用 Delta T 方法处理的配药数据与 EM 数据中度相关。最后两次续药的 Delta T 值有望估计不规则依从性，提示在药房实践中可能需要有针对性的干预措施。
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