Abel Dori, Anderson David, Kallan Michael J, Utidjian Levon, Burnham Jon M, Chang Joyce C, Kenyon Chén C, Gmuca Sabrina
The Children's Hospital of Philadelphia and The Perelman School of Medicine, University of Pennsylvania, Philadelphia.
The Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Arthritis Care Res (Hoboken). 2025 Mar;77(3):300-308. doi: 10.1002/acr.25441. Epub 2024 Oct 25.
We linked pharmacy dispensing data to clinical data in the electronic health record (EHR) to (1) identify characteristics associated with adherence to methotrexate (MTX) and (2) determine the association between adherence and disease activity in patients with juvenile idiopathic arthritis (JIA).
We conducted a single-center retrospective cohort study of incident MTX recipients with JIA treated between January 2016 and September 2023 for ≥12 months. Using pharmacy dispensing data, complemented by EHR data, we estimated adherence using medication possession ratios (MPRs) over the first 365 days of treatment. We used Fisher's exact and Wilcoxon rank-sum tests to compare patient characteristics between adherent (MPR ≥80%) and nonadherent (MPR <80%) groups and multivariable linear regression to investigate associations between MPR and active joint count.
Among 224 patients, 81 (36.2%) were classified as nonadherent. In bivariate analysis, patients of younger age, of Black race, and from areas with lower child opportunity index were more likely to be classified as nonadherent. In multivariable analysis, active joint count changed from baseline to 12-month follow-up by -0.38 joints in the adherent compared to nonadherent group (95% confidence interval [CI] -0.74 to -0.01) and by -1.18 joints in patients with polyarticular course (95% CI -2.23 to -0.13).
Linking dispense data to clinical EHR data offers a novel, objective method for evaluating adherence to chronic medications. We identified demographic and area-level determinants of adherence, along with small but statistically significant differences in JIA disease activity measures by adherence status. Future work is needed to evaluate adherence as a potential mediator of known outcome disparities for socially disadvantaged populations.
我们将药房配药数据与电子健康记录（EHR）中的临床数据相链接，以（1）确定与甲氨蝶呤（MTX）依从性相关的特征，以及（2）确定青少年特发性关节炎（JIA）患者的依从性与疾病活动度之间的关联。
我们对2016年1月至2023年9月期间接受MTX治疗≥12个月的JIA初治患者进行了一项单中心回顾性队列研究。利用药房配药数据，并辅以EHR数据，我们在治疗的前365天使用药物持有率（MPR）来估计依从性。我们使用Fisher精确检验和Wilcoxon秩和检验来比较依从组（MPR≥80%）和非依从组（MPR<80%）之间的患者特征，并使用多变量线性回归来研究MPR与活动关节计数之间的关联。
在224例患者中，81例（36.2%）被归类为非依从。在双变量分析中，年龄较小、黑人种族以及来自儿童机会指数较低地区的患者更有可能被归类为非依从。在多变量分析中，与非依从组相比，依从组从基线到12个月随访时活动关节计数变化为-0.38个关节（95%置信区间[CI]-0.74至-0.01），多关节病程患者变化为-1.18个关节（95%CI-2.23至-0.13）。
将配药数据与临床EHR数据相链接为评估慢性药物依从性提供了一种新颖、客观的方法。我们确定了依从性的人口统计学和地区水平决定因素，以及依从状态在JIA疾病活动度测量方面虽小但具有统计学意义的差异。未来需要开展工作，将依从性评估为社会弱势群体已知结局差异的潜在中介因素。
