Assuming one dose per day yields a similar estimate of medication adherence in patients with stroke: An exploratory analysis using linked registry data. Issue 3 (23rd July 2020)

• Record Type: Journal Article
• 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.
• Is Part Of: British journal of clinical pharmacology. Volume 87:Issue 3(2021)
• Page Start: 1089
• Page End: 1097
• Publication Date: 2020-07-23
• Subjects: antihypertensive agents -- cohort studies -- databases -- drug prescriptions -- drug utilisation -- hypertension -- pharmacoepidemiology -- registries -- secondary prevention -- stroke; Pharmacology -- Periodicals; Drugs -- Periodicals; 615.1
• DOI: 10.1111/bcp.14468
• Languages: English
• ISSNs: 0306-5251

Abstract

Abstract : Purpose: 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 (i) one dose per day (1DD), (ii) an estimate based on the 75th percentile of days taken by patients to refill a script (PDD75 ) or (iii) the World Health Organization'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. Methods: 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. Results: Among 12 628 eligible patients with stroke, 10 057 (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 two tablets/day). There were comparable levels of adherence between 1DD and the PDD75 (median PDC 91.0% vs 91.2%; P = 0.70), but adherence was slightly higher using DDD (92.3%; both P < 0.001). However, this would represent a clinically nonsignificant difference. Conclusion: Adherence to antihypertensive medications shows similar estimates across standard measures of dosage in patients during the first year after an acute stroke.