Operationalization and validation of a novel method to calculate adherence to polypharmacy with refill data from the Australian pharmaceutical benefits scheme (PBS) database

• Main Authors: Arnet I, Greenland M, Knuiman MW, Rankin JM, Hung J, Nedkoff L, Briffa TG, Sanfilippo FM
• Format: Article in Journal/Newspaper
• Language: English
• Published: Dove Medical Press 2018
• Subjects: Medication adherence; claims databases; Pharmaceutical Benefits Scheme; algorithm; operationalization; Infectious and parasitic diseases; RC109-216; Greenland; Murdoch
• Online Access: https://doaj.org/article/ea9639571de84d398a3c7d9c033bee6b

Isabelle Arnet,1 Melanie Greenland,2 Matthew W Knuiman,2 Jamie M Rankin,3 Joe Hung,4 Lee Nedkoff,2 Tom G Briffa,2 Frank M Sanfilippo2 1Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland; 2School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia; 3Cardiology Department, Fiona Stanley Hospital Murdoch, WA, Australia; 4School of Medicine, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, WA, Australia Background: Electronic health care data contain rich information on medicine use from which adherence can be estimated. Various measures developed with medication claims data called for transparency of the equations used, predominantly because they may overestimate adherence, and even more when used with multiple medications. We aimed to operationalize a novel calculation of adherence with polypharmacy, the daily polypharmacy possession ratio (DPPR), and validate it against the common measure of adherence, the medication possession ratio (MPR) and a modified version (MPRm). Methods: We used linked health data from the Australian Pharmaceutical Benefits Scheme and Western Australian hospital morbidity dataset and mortality register. We identified a strict study cohort from 16,185 patients aged ≥65 years hospitalized for myocardial infarction in 2003–2008 in Western Australia as an illustrative example. We applied iterative exclusion criteria to standardize the dispensing histories according to previous literature. A SAS program was developed to calculate the adherence measures accounting for various drug parameters. Results: The study cohort was 348 incident patients (mean age 74.6±6.8 years; 69% male) with an admission for myocardial infarction who had cardiovascular medications over a median of 727 days (range 74 to 3,798 days) prior to readmission. There were statins (96.8%), angiotensin converting enzyme inhibitors (88.8%), beta-blockers ...