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Title: Assuming one dose per day yields a similar estimate of medication adherence in patients with stroke: an exploratory analysis using linked registry data.
Austin Authors: Ung, David;Dalli, Lachlan L;Lopez, Derrick;Sanfilippo, Frank M;Kim, Joosup;Andrew, Nadine E;Thrift, Amanda G;Cadilhac, Dominique A;Anderson, Craig S;Kilkenny, Monique F
Affiliation: The George Institute for Global Health Australia, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
The George Institute for Global Health China at Peking University Health Science Center, China
Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
Issue Date: Mar-2021 2020-07-08
Publication information: British Journal of Clinical Pharmacology 2021; 87(3): 1089-1097
Abstract: Prescribed daily dose (PDD), the number of doses prescribed to be taken per day, is used to calculate medication adherence using pharmacy claims data. PDD can be substituted by (1) 1 dose per day (1DD), (2) an estimate based on the 75th percentile of days taken by patients to refill a script (PDD75 ) or (3) the World Health Organisation's defined daily dose (DDD). We aimed to compare these approaches for estimating the duration covered by medications and whether this affects calculated 1-year adherence to antihypertensive medications post-stroke. We conducted a retrospective review of prospective cohort data from the ongoing Australian Stroke Clinical Registry linked with pharmacy claims data. Adherence was calculated as the proportion of days covered (PDC) for 1DD, PDD75 , and DDD. Differences were assessed using Wilcoxon rank-sum tests. Among 12628 eligible patients with stroke, 10057 (80%) were prescribed antihypertensive medications in the year after hospital discharge (78.2% aged ≥65 years, 45.2% female). Overall, the 75th percentile of patient time until next medication refill was 39 days. The greatest variations in dose regimens, estimated using person- and dose-level refill times, were for beta blockers (11.4% taking 2 tablets/day). There were comparable levels of adherence between 1DD and the PDD75 (median PDC 91.0% versus 91.2%; P=0.70), but adherence was slightly higher using DDD (92.3%; both P<0.001). However, this would represent a clinically non-significant difference. Adherence to antihypertensive medications shows similar estimates across standard measures of dosage in patients during the first year after an acute stroke.
DOI: 10.1111/bcp.14468
ORCID: 0000-0002-7931-6387
PubMed URL: 32643250
Type: Journal Article
Subjects: antihypertensive agents
cohort studies
drug prescriptions
drug utilization
secondary prevention
Appears in Collections:Journal articles

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