Proportion of days covered as a measure of medication adherence

Loucks, Jennifer; Zuckerman, Autumn D; Berni, Angelica; Saulles, Adam; Thomas, Gosia; Alonzo, Amy

doi:10.1093/ajhp/zxab392

Cited by 39 publications

(37 citation statements)

References 17 publications

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“…In addition, established thresholds for dichotomous, summary measures of adherence may misidentify patients and not correlate with clinical outcomes of care in contrast with more continuous measures of adherence. 15 The PDC measure has also been subject to critique because it can be influenced by 90-day refill programs and automated refill reminders. 26 Recognizing these concerns, the adherence measures reported were observed over a lengthy 37-month longitudinal observation period and presented in multiple ways to ensure comprehensive understanding of the adherence patterns.…”

Section: Discussionmentioning

confidence: 99%

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Beyond Antiretroviral Treatment: Patterns and Factors Associated With Composite Medication Adherence Before and During the COVID-19 Pandemic in Patients With HIV With Multiple Chronic Conditions

Miller

Eberhart

Jefferson

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Polypharmacy for multiple chronic conditions (MCCs) poses an increasing challenge in people with HIV (PWH). This research explores medication adherence in PWH with MCCs before and during COVID-19.Setting: Kaiser Permanente Mid-Atlantic States.Methods: Medical and pharmacy records of a continuously enrolled cohort (September 2018-September 2021) of adult PWH were used. To estimate medication adherence, monthly proportion of days covered (PDC) was measured individually for antiretrovirals (ARVs), diabetes medications (DMs), renin-angiotensin antagonists (RASMs), and statins (SMs) and combined into composite measures (CMs) with and without ARVs. Descriptive statistics, time-series models, and multivariable population-averaged panel general estimating equations were used to profile trends, effects, and factors associated with adherence. Results:The cohort (n = 543) was predominantly 51-64 years old (59.3%), Black (73.1%), male (69.2%), and commercially insured (65.4%). Two-thirds (63.7%) of patients were taking medications in 2 medication groups (ie, ARVs and either DMs, RASMs, or SMs), 28.9% were taking medications in 3 medication groups, and 7.4% were taking medications in all 4 medication groups. Overall, PDC for CMs without ARVs was 77.2% and 70.2% with ARVs. After March 2020, negative monthly trends in PDC were observed for CMs without ARVs (b = 20.1%, P = 0.003) and with ARVs (b = 20.3%, P = 0.001). For CMs with ARVs, Black race (aOR = 0.5; P , 0.001; ref: White) and taking medications for 3 medication groups (aOR = 0.8; P , 0.02; ref: 2) were associated with lower adherence. Conclusion:Decreasing medication adherence trends were observed during the COVID-19 pandemic with variations among population subgroups. Opportunity exists to improve medication adherence for non-White populations and those taking medications for MCCs beyond ARVs.

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Section: Discussionmentioning

confidence: 99%

“…The PDC is a surrogate or indirect measure of medication adherence that reflects the intermediate step of prescription fulfillment falling between prescribing and actual medication-taking and recognized as a preferred metric commonly used by quality organizations and payors for performance reporting. 1,5,15…”

Section: Methodsmentioning

confidence: 99%

Beyond Antiretroviral Treatment: Patterns and Factors Associated With Composite Medication Adherence Before and During the COVID-19 Pandemic in Patients With HIV With Multiple Chronic Conditions

Miller

Eberhart

Jefferson

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…The level of non-adherence was estimated by the non-exposure to the PAP, using the percentage of Days without Treatment (%DwT)” ( 15 ), which was calculated over the 12 months following inclusion. It was assumed that each dispensing covered 30 days, regardless of the quantity or dosage dispensed.…”

Section: Methodsmentioning

confidence: 99%

Antipsychotic prescribing practices in real-life (APPREAL study): Findings from the French National Healthcare System Database (2007–2017)

Rolland¹,

Dalon²,

Gauthier³

et al. 2022

Front. Psychiatry

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BackgroundAntipsychotics are used in a large variety of psychiatric and neurological disorders; investigating their use in real life is important to understand national prescribing practices, as well as to determine the levels of patient adherence.MethodsUsing a 1/97e random sample (General Sample of Beneficiaries, EGB) of the French health insurance reimbursement database, we conducted a historical cohort study on the 2007–2017 period. The aim was to describe the sociodemographic characteristics of patients, the types of antipsychotics dispensed, the types of prescribers, the mean doses and average durations of treatment, the co-dispensed medications, and the levels of adherence to treatment. To exclude punctual uses of antipsychotics, we selected only patients with a continuous dispensing of the same antipsychotic over at least 3 months.ResultsIn total, 13,799 subjects (1.66% of the EGB sample) were included (56.0% females; mean age 55.8 ± 19.4 years). Risperidone (19.3%), cyamemazine (18.7%), olanzapine (11.9%), tiapride (8.8%), and haloperidol (7.5%) were the five most prescribed antipsychotics. 44.9% of prescriptions were written by general practitioners, 34.1% by hospital practitioners, and 18.4% by private-practice psychiatrists. On average, the mean dispensed doses were relatively low, but the variation range was large. Long-acting forms were used in 5.4% of the sample, and clozapine in 1.3%. 34.2% of patients received more than one antipsychotic, and almost 15% were prescribed at least three concomitant antipsychotics. Paliperidone and clozapine were associated with the highest levels of adherence, and risperidone and haloperidol with the lowest ones.ConclusionAn important heterogeneity of antipsychotic prescribing practices was observed in France. The rate of use of long-acting antipsychotics was low, whereas multiple antipsychotic prescriptions were frequent.

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“…The study's outcomes of medication use patterns included adherence [defined via a continuous measure of proportion of days covered (PDC)] and persistence (defined as the continuous or count number of 45-day treatment gaps). Of note, PDC remains a recommended approach to measuring adherence, and is calculated as the number of days covered by the medication divided by the number of days in the study period following the index date until the end of follow-up (i.e., the number of days in the measurement period) [26]. Additional study outcomes included any all-cause 30-day readmission to the ED or hospital and costs, defined as total comprehensive direct medical costs from the perspective of a Medicaid payer (i.e., complete medical, ambulatory, inpatient, ED, procedure, pharmacy, home health, and other administrative claims).…”

Section: Methodsmentioning

confidence: 99%

Adherence, Persistence, Readmissions, and Costs in Medicaid Members with Schizophrenia or Schizoaffective Disorder Initiating Paliperidone Palmitate Versus Switching Oral Antipsychotics: A Real-World Retrospective Investigation

et al. 2022

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Introduction: Long-acting injectable antipsychotic agents have been suggested to improve adherence and patient outcomes in schizophrenia or schizoaffective disorder. The purpose of this study was to assess medication use patterns (i.e., medication adherence, persistence), hospital and emergency department readmissions, and total direct medical costs of Oklahoma Medicaid members with schizophrenia or schizoaffective disorder switching from an oral antipsychotic (OAP) to once-monthly paliperidone palmitate (PP1M) or to another OAP (OAP-switch).

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Proportion of days covered as a measure of medication adherence

Cited by 39 publications

References 17 publications

Beyond Antiretroviral Treatment: Patterns and Factors Associated With Composite Medication Adherence Before and During the COVID-19 Pandemic in Patients With HIV With Multiple Chronic Conditions

Beyond Antiretroviral Treatment: Patterns and Factors Associated With Composite Medication Adherence Before and During the COVID-19 Pandemic in Patients With HIV With Multiple Chronic Conditions

Antipsychotic prescribing practices in real-life (APPREAL study): Findings from the French National Healthcare System Database (2007–2017)

Adherence, Persistence, Readmissions, and Costs in Medicaid Members with Schizophrenia or Schizoaffective Disorder Initiating Paliperidone Palmitate Versus Switching Oral Antipsychotics: A Real-World Retrospective Investigation

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