Understanding Adherence and Prescription Patterns Using Large-Scale Claims Data

Bjarnadóttir, Margrét V.; Malik, Sana; Onukwugha, Eberechukwu; Gooden, Tanisha; Plaisant, Catherine

doi:10.1007/s40273-015-0333-4

Cited by 17 publications

(7 citation statements)

References 24 publications

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“…Treatment failure was also evaluated during follow-up, defined as the occurrence of discontinuation of SGLT2i or switch from SGLT2i to another T2D medication class; or addition of another T2D medication class not used in baseline; or initiation of insulin (see Additional File 1 : Table S1 for a complete listing of all treatments considered). We applied a conservative grace period of 90 days between two consecutive refills before counting SGLT2i treatment as discontinued [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

Predictors of cardio-kidney complications and treatment failure in patients with chronic kidney disease and type 2 diabetes treated with SGLT2 inhibitors

Kövesdy

Schmedt

Folkerts

et al. 2022

BMC Med

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Background Clinical practice guidelines recommend sodium-glucose co-transporter 2 inhibitors (SGLT2is) to mitigate adverse kidney and cardiovascular outcomes in patients with type 2 diabetes (T2D), including patients with comorbid chronic kidney disease (CKD), also referred to as diabetic kidney disease (DKD), who are at even higher risk. In this study, we sought to identify predictors of cardio-kidney events, cardio-kidney complications, and treatment failure (i.e., addition/initiation of a new T2D class, insulin, or discontinuation of SGLT2is) after new initiation of SGLT2is in patients with CKD and T2D (DKD). Methods In this retrospective cohort study, we identified adult patients with DKD who initiated SGLT2is between April 1, 2012, and June 30, 2019, in Optum claims data. Outcome rates per 1000 person-years (PY) are reported with 95% confidence intervals (CIs). Cox proportional hazards regression identified patient characteristics associated with each outcome. Results The study population consisted of 6389 initiators of SGLT2is. The rate of CV hospitalization was 26.0 (95% CI 21.6, 30.4) per 1000 PY. Baseline characteristics associated with higher risk of CV hospitalization included age, atrial fibrillation, peripheral vascular disease (PVD), and cancer. The rate of kidney hospitalization was 12.0 (95% CI 9.0, 15.0) per 1000 PY. The risk increased significantly with baseline evidence of heart failure, hyperkalemia, respiratory failure, depression, and use of loop diuretics. In total, 55.0% of all SGLT2i initiators discontinued treatment during the follow-up period. The rate of treatment failure was 510.5 (95% CI 492.9, 528.1) per 1000 PY. Analysis of key time-dependent SGLT2i-associated adverse events showed that experiencing diabetic ketoacidosis and volume depletion were associated with risk of treatment failure. Conclusions Our study demonstrated high rates of residual cardio-kidney outcomes and treatment failure in patients with DKD treated with SGLT2is. Patients with high baseline CV risk and the presence of certain conditions, such as atrial fibrillation, PVD, and heart failure, were at higher risk for cardio-kidney events. Further research is needed to assess the potential relationship between adverse events and SGLT2i treatment failure.

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Section: Methodsmentioning

confidence: 99%

Predictors of cardio-kidney complications and treatment failure in patients with chronic kidney disease and type 2 diabetes treated with SGLT2 inhibitors

Kövesdy

Schmedt

Folkerts

et al. 2022

BMC Med

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“…Using pharmacy refill data and MPR to calculate adherence has its limitations, as it must be assumed that the medication dispensed was correctly taken by the patient. 11,34,47,48 Unfortunately, MPR calculated from pharmacy refill data cannot give information on how and when patients took their medication. 47 Another limitation to this study was the limited number of data points for CD4 count and VL, which restricted the use of inferential statistics.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Adherence and clinical outcomes of HIV patients switching to a fixed-dose combination regimen

Kruger-Swanepoel

Lubbe²,

Rakumakoe³

et al. 2022

Southern African Journal of Infectious Diseases

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Background: The efficacy of antiretroviral therapy (ART) is monitored using clinical markers such as viral load (VL) and CD4 counts. Adherence to ART has been associated with viral suppression and improved clinical outcomes.Objectives: To determine the relationship between adherence status with multiple-tablet regimens (MTR) and fixed-dose combination (FDC) regimens, to weight, CD4 count and VL of patients living with HIV.Method: An observational, descriptive study was conducted on a closed cohort of patients living with HIV and attending a primary health care clinic in Northern Cape in South Africa between 01 January 2013 and 31 December 2015. Patients were on an MTR and changed to an FDC regimen. Adherence was measured using the medicine possession ratio (MPR).Results: Statistically significant differences exist between the mean MPR of the 30-day (p = 0.0308) and 28-day supply (p 0.0001) of the MTR when compared to FDC regimen. No statistically significant differences could be found between adherence and clinical outcomes such as weight, CD4 count and VL for either MTR or FDC regimens. The suppressed VL values measured for MTR were n = 299 (89.25%) and n = 415 (93.05%) for FDC regimen.Conclusion: Adherence improved when patients were switched to FDC, but no statistically significant differences in clinical outcomes measured as weight, CD4 count and VL between adherence status and regimen type could be found.Contribution: This study contributes to much-needed information about ART adherence and clinical outcomes (such as weight, CD4 count and VL) of adult HIV-positive patients in a public healthcare clinic in the Northern Cape, South Africa.

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“…Building on LifeLine2 and LifeFlow, Monroe et al [28,29] developed EventFlow that provides advanced capability for searching event sequences. They demonstrated through real-life use cases (e.g., [4,6,27]) that complex queries are of importance for answering real-life questions by real users. Driven by this line of research, advanced query capabilities are introduced into other applications [8,9,17,19,20,22,42,46].…”

Section: Query-centric Interfacesmentioning

confidence: 99%

MAQUI: Interweaving Queries and Pattern Mining for Recursive Event Sequence Exploration

Law

Liu

Malik

et al. 2019

IEEE Trans. Visual. Comput. Graphics

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Exploring event sequences by defining queries alone or by using mining algorithms alone is often not sufficient to support analysis. Analysts often interweave querying and mining in a recursive manner during event sequence analysis: sequences extracted as query results are used for mining patterns, patterns generated are incorporated into a new query for segmenting the sequences, and the resulting segments are mined or queried again. To support flexible analysis, we propose a framework that describes the process of interwoven querying and mining. Based on this framework, we developed MAQUI, a Mining And Querying User Interface that enables recursive event sequence exploration. To understand the efficacy of MAQUI, we conducted two case studies with domain experts. The findings suggest that the capability of interweaving querying and mining helps the participants articulate their questions and gain novel insights from their data.

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Understanding Adherence and Prescription Patterns Using Large-Scale Claims Data

Cited by 17 publications

References 24 publications

Predictors of cardio-kidney complications and treatment failure in patients with chronic kidney disease and type 2 diabetes treated with SGLT2 inhibitors

Predictors of cardio-kidney complications and treatment failure in patients with chronic kidney disease and type 2 diabetes treated with SGLT2 inhibitors

Adherence and clinical outcomes of HIV patients switching to a fixed-dose combination regimen

MAQUI: Interweaving Queries and Pattern Mining for Recursive Event Sequence Exploration

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