University of South Australia, UniSA Clinical & Health Sciences, Adelaide, Australia.
South Australian Health and Medical Research Institute, Adelaide, Australia.
Pharmacoepidemiol Drug Saf. 2024 Dec;33(12):e70065. doi: 10.1002/pds.70065.
To compare the accuracy of pharmaceutical claims with medication administration chart data for individuals in long-term care facilities (LTCFs).
Secondary analyses of a prospective cohort study (n = 279 residents, 5 LTCFs) were conducted. Details of medications charted for regular administration at study enrollment were extracted from administration charts and coded using Anatomical Therapeutic Chemical (ATC) classification codes. Pharmaceutical claims for government-subsidized medications dispensed in the 0-30, 0-60, 0-90, 0-120, and 0-180 days before study enrollment were compared to medication chart data (reference standard). Sensitivity, specificity, and positive predictive value (PPV) and 95% CIs were determined at the 3- and 7-digit ATC levels.
149 (53.4% of total) residents with both medication chart and claims data available were included. The proportion of PPVs ≥ 75% for 3-digit ATC level medications was 89.4% and 86.1% using exposure windows of 30 and 180-days for claims, respectively. Using a 120-day exposure window for claims, sensitivity was highest for diabetes agents, beta-blocking agents, calcium channel blockers, agents acting on the renin-angiotensin system, anti-Parkinson drugs, psychoanaleptics, and airways disease agents (all ≥ 90%) and was lowest for vitamins (1.4%, 95% CI 0-7.7) and mineral supplements (10.3%, 95% CI 2.9-24.2). Specificity was ≥ 85% for all 3-digit level medications within each exposure window other than antibacterials and analgesics.
Pharmaceutical claims data has good accuracy for determining prescription medication exposure in LTCFs. Exposure windows of 90-120-days are generally sufficient for determining exposure although longer periods may be required for large pack sizes.
比较长期护理机构（LTCF）个体的药品报销与用药管理图表数据的准确性。
对一项前瞻性队列研究（n=279 名居民，5 家 LTCF）进行二次分析。从管理图表中提取研究入组时定期管理的用药明细，并使用解剖治疗化学（ATC）分类代码进行编码。将研究入组前 0-30、0-60、0-90、0-120 和 0-180 天内政府补贴药品的配药报销与用药图表数据（参考标准）进行比较。在 3 位和 7 位 ATC 水平确定了灵敏度、特异性和阳性预测值（PPV）和 95%置信区间。
149 名（总人数的 53.4%）同时有用药图表和报销数据的居民被纳入分析。3 位 ATC 水平药物的 PPV≥75%的比例分别为 89.4%和 86.1%，使用的报销暴露窗口分别为 30 天和 180 天。使用 120 天的报销暴露窗口，糖尿病药物、β受体阻滞剂、钙通道阻滞剂、肾素-血管紧张素系统药物、抗帕金森药物、精神兴奋药和气道疾病药物的敏感性最高（均≥90%），而维生素（1.4%，95%CI 0-7.7）和矿物质补充剂（10.3%，95%CI 2.9-24.2）的敏感性最低。除了抗菌药物和止痛药物外，所有 3 位 ATC 水平药物的特异性在每个暴露窗口均≥85%。
药品报销数据在确定 LTCF 中处方药暴露方面具有较高的准确性。90-120 天的暴露窗口通常足以确定暴露情况，尽管对于大包装尺寸可能需要更长的时间。
