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Oct 25, 2022 99 likes •268 views

Concordance of Pharmacy Claims and Wireless Pill Bottles for Measurement of Medication Adherence Shivan Mehta, MD, MBA, MSHP Assistant Professor of Medicine and Health Policy University of Pennsylvania Medication adherence post-MI With free

SLIDE 1

Concordance of Pharmacy Claims and Wireless Pill Bottles for Measurement

f Medication Adherence

Shivan Mehta, MD, MBA, MSHP Assistant Professor of Medicine and Health Policy University of Pennsylvania

SLIDE 2

Medication adherence post-MI

Source: Jackevicius CA, et al JAMA, Choudhry et al NEJM

With free medications, statin adherence increased from 49% to 55%

SLIDE 3

Measurement of Adherence

Administration Accuracy Self report Moderate Questionable accuracy, and limited time frame Pill count Difficult Good accuracy, but challenging to administer Pharmacy claims Easy Most widely used, but

nly measures filling of

meds Electronic pill bottles Moderate Measures opening but needs to be used properly

SLIDE 4

Objectives

Evaluate the concordance of pharmacy claims and

wireless pill bottles for measuring medication adherence

Correlate medication adherence measures with

clinical outcomes among myocardial infarction patients

SLIDE 5

Study context

Pragmatic trial of heart attack patients randomizing 1509 in 2:1 ratio to the following intervention for 12 months:

1. Wireless pill bottles for cardiovascular meds
2. Engagement incentives with daily lotteries

conditional on adherence

3. Social incentive - Friend or family member

gets automate alerts

4. Assignment of an engagement advisor as

needed

SLIDE 6

Methods

Include participants in the intervention group

(n=1003) for whom we had 12 months of pharmacy data (n=456)

– Pharmacy claims adherence measured using proportion of days covered (PDC) – Pill bottle adherence measured using percent of days with cap opening

Clinical outcome was time to first vascular

readmission or death

SLIDE 7

Medication adherence measures

Pharmacy claims Electronic pill bottles Strict Prescribed medication for entire study period Adherence measurement for entire study period for study medication Intermediate Prescribed medication for the entire study period if they ever filled that medication after discharge Adherence measurement for entire study period if they ever

pened a bottle

Relaxed Prescribed medication from time of first fill until the end

f the study period

Adherence from the first bottle

pening date

SLIDE 8

Statistical analysis

Pearson correlation coefficient (r) of the annual

adherence measures

Unadjusted cox proportional hazard models used to

evaluate association of clinical outcomes and adherence to statins

– Model fit examined with Akaike information criteria (AIC) and Bayesian information criteria (BIC) – Additional value of both adherence measures using likelihood ratio (LR) test

SLIDE 9

Patient characteristics

12-month continuous coverage N 456 Female, No. (%) 160 (35.1) Age, Mean (SD) 61.9 (10.2) Medicare, No. (%) 253 (55.5) Baseline Elixhauser Score, Mean (SD) 6.5 (10.1) # Days Between Index Discharge and Enrollment, Mean (SD) 40.9 (12.0) Region, No. (%) …Northeast 138 (30.3) …Midwest 75 (16.5) …South 212 (46.5) …West 31 (6.8)

SLIDE 10

Pharmacy claims data

.1 .2 .3 .4 .5 .6 .7 .8 .9 1 30 60 90 120 150 180 210 240 270 300 330 360 Days Since Enrollment Strict Intermediate Relaxed

PDC Statin

SLIDE 11

Electronic pill bottle data

.1 .2 .3 .4 .5 .6 .7 .8 .9 1 30 60 90 120 150 180 210 240 270 300 330 360 Days Since Enrollment Strict Intermediate Relaxed

GlowCap Statin

SLIDE 12

Correlation of two measures

.2 .4 .6 .8 1 PDC .2 .4 .6 .8 1 GlowCap

Statin Adherence (PDC vs GlowCap)

Annual statin adherence using PDC = 0.73 and GC = 0.70.
Pearson’s r = 0.14 (p = 0.004)

SLIDE 13

Results

GC statin adherence and time to first vascular event

was statistically significant (HR = 0.327; 95% CI = 0.150 - 0.711; p = 0.01).

PDC statin adherence and time to vascular event was

not statistically significant (HR = 0.633; 95% CI = 0.258 – 1.556; p=0.32).

Adding the GC adherence variable to the model

using only PDC improved the model fit (LR test p = 0.009), but not vice versa (p = 0.51).

SLIDE 14

Conclusion

Pharmacy claims and electronic pill bottle data were

correlated, but with missing data

Electronic pill data had greater association with

clinical outcomes than pharmacy claims alone and when combined

Policies and programs that rely on pharmacy claims

may not fully account for medication adherence

SLIDE 15

Study Team

David A. Asch, MD, MBA
Andrea B. Troxel, ScD
Raymond Lim, MA
Jennifer Lewey, MD, MPH
Wenli Wang, MS
Jingsan Zhu, MBA
Laurie Norton, MA
Noora Marcus, MA
Kevin G. Volpp, MD, PhD