Normalizing Vocabulary and Descriptions of Medicine Observance in Research Engaging Electronic Catalogues

Abstract

Analytic Methods Standardizing Terminology and Definitions of Medication Adherence and Persistence in Research Employing Electronic Databases

Raebel, Marsha A. PharmD^*,†; Schmittdiel, Julie PhD^‡; Karter, Andrew J. PhD^‡; Konieczny, Jennifer L. PharmD^†; Steiner, John F. MD, MPH^*,§

Author Information Medical Care 51():p S11-S21, August 2013. | DOI: 10.1097/MLR.0b013e31829b1d2a

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Metrics Abstract Objective: 

To propose a unifying set of definitions for prescription adherence research utilizing electronic health record prescribing databases, prescription dispensing databases, and pharmacy claims databases and to provide a conceptual framework to operationalize these definitions consistently across studies.

Methods: 

We reviewed recent literature to identify definitions in electronic database studies of prescription-filling patterns for chronic oral medications. We then develop a conceptual model and propose standardized terminology and definitions to describe prescription-filling behavior from electronic databases.

Results: 

The conceptual model we propose defines 2 separate constructs: medication adherence and persistence. We define primary and secondary adherence as distinct subtypes of adherence. Metrics for estimating secondary adherence are discussed and critiqued, including a newer metric (New Prescription Medication Gap measure) that enables estimation of both primary and secondary adherence.

Discussion: 

Terminology currently used in prescription adherence research employing electronic databases lacks consistency. We propose a clear, consistent, broadly applicable conceptual model and terminology for such studies. The model and definitions facilitate research utilizing electronic medication prescribing, dispensing, and/or claims databases and encompasses the entire continuum of prescription-filling behavior.

Conclusion: 

Employing conceptually clear and consistent terminology to define medication adherence and persistence will facilitate future comparative effectiveness research and meta-analytic studies that utilize electronic prescription and dispensing records.

BACKGROUND

The construct of medication adherence comprises a set of inter-related health behaviors.¹ One of these behaviors, the act of filling a medication prescription, can be estimated objectively using electronic databases such as electronic insurance claims or pharmacy dispensing databases. Numerous studies have assessed patterns of prescription refills among individuals who obtain at least 1 fill of a medication.^2–11 Over the last several years, advances in electronic prescribing and medication order entry within the electronic health record (EHR) have expanded our ability to assess whether or not patients obtain their initial prescriptions, another of the health behaviors within the adherence cluster.^12–17 Although EHR prescribing databases vary in whether or not they contain information on dispensed prescriptions, their use can enhance widely available pharmacy dispensing and pharmacy insurance claims database to better describe the sequence of behaviors that are necessary to achieve desirable treatment outcomes.