Shivan J Mehta1,2,3, David A Asch1,2,3,4, Andrea B Troxel5, Raymond Lim2,3, Jennifer Lewey1, Wenli Wang2, Jingsan Zhu2, Laurie Norton2, Noora Marcus2, Kevin G Volpp1,2,3,4. 1. Department of Medicine, Perelman School of Medicine. 2. Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania. 3. Penn Medicine Center for Health Care Innovation. 4. Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA. 5. Department of Population Health, Division of Biostatistics, NYU School of Medicine, New York, NY.
Abstract
BACKGROUND:Medication adherence after myocardial infarction remains low. Pharmacy claims have typically been used to measure medication adherence, but electronic pill bottles may offer additional information. OBJECTIVE: The main objectives of this study were to compare the association of adherence measured by prescription claims and remote monitoring technologies with cardiovascular events. RESEARCH DESIGN: This study was a secondary analysis of a remote monitoring intervention to increase medication adherence in myocardial infarction patients. SUBJECTS: In total, 682 myocardial infarction patients were randomized to the intervention group with both medical and pharmacy benefits. MEASURES: Pharmacy claims adherence was measured using proportion of days covered (PDC) and GlowCap adherence (GC) was measured as the proportion of days the pill bottle was opened. We compared the association of PDC and GC adherence for statins with time to first vascular readmission or death and assessed model fit using Akaike information criterion and Bayesian information criterion and the likelihood ratio test. RESULTS: Higher PDC was significantly associated with a lower hazard rate for vascular readmissions or death (hazard ratio=0.435; P=0.009). There was also an association between GC adherence and vascular readmissions or death (hazard ratio=0.313; P≤0.001). Adding the GC adherence variable to the model using only PDC improved the model fit (likelihood ratio test, P=0.001), as well as vice versa (P=0.050). CONCLUSIONS: Pharmacy claims data provide useful but not complete data for medication adherence monitoring. New wireless technologies have the potential to provide additional data about clinical outcomes.
RCT Entities:
BACKGROUND: Medication adherence after myocardial infarction remains low. Pharmacy claims have typically been used to measure medication adherence, but electronic pill bottles may offer additional information. OBJECTIVE: The main objectives of this study were to compare the association of adherence measured by prescription claims and remote monitoring technologies with cardiovascular events. RESEARCH DESIGN: This study was a secondary analysis of a remote monitoring intervention to increase medication adherence in myocardial infarctionpatients. SUBJECTS: In total, 682 myocardial infarctionpatients were randomized to the intervention group with both medical and pharmacy benefits. MEASURES: Pharmacy claims adherence was measured using proportion of days covered (PDC) and GlowCap adherence (GC) was measured as the proportion of days the pill bottle was opened. We compared the association of PDC and GC adherence for statins with time to first vascular readmission or death and assessed model fit using Akaike information criterion and Bayesian information criterion and the likelihood ratio test. RESULTS: Higher PDC was significantly associated with a lower hazard rate for vascular readmissions or death (hazard ratio=0.435; P=0.009). There was also an association between GC adherence and vascular readmissions or death (hazard ratio=0.313; P≤0.001). Adding the GC adherence variable to the model using only PDC improved the model fit (likelihood ratio test, P=0.001), as well as vice versa (P=0.050). CONCLUSIONS: Pharmacy claims data provide useful but not complete data for medication adherence monitoring. New wireless technologies have the potential to provide additional data about clinical outcomes.
Authors: Saul Blecker; Samrachana Adhikari; Hanchao Zhang; John A Dodson; Sunita M Desai; Lisa Anzisi; Lily Pazand; Antoinette M Schoenthaler; Devin M Mann Journal: J Manag Care Spec Pharm Date: 2021-10
Authors: Julie C Lauffenburger; Elad Yom-Tov; Punam A Keller; Marie E McDonnell; Lily G Bessette; Constance P Fontanet; Ellen S Sears; Erin Kim; Kaitlin Hanken; J Joseph Buckley; Renee A Barlev; Nancy Haff; Niteesh K Choudhry Journal: BMJ Open Date: 2021-12-03 Impact factor: 2.692
Authors: Constance P Fontanet; Niteesh K Choudhry; Wendy Wood; Ted Robertson; Nancy Haff; Rebecca Oran; Ellen S Sears; Erin Kim; Kaitlin Hanken; Renee A Barlev; Julie C Lauffenburger; Candace H Feldman Journal: BMJ Open Date: 2021-11-24 Impact factor: 2.692