Evidence In The Public Arena + Pharmacoepidemiology measures

• List sources for obtaining health news.

• Identify current issues that are challenging health care reporting.

• Describe review criteria for evaluating news media reporting of healthcare news.

• Apply these criteria to evaluate articles about healthcare in the public media.

Learning Objectives

• The public obtains healthcare information from a variety of sources
  

• Patients rely on pharmacists to provide accurate information

• Pharmacists should participate in the dissemination and assessment of scientific evidence through the general media

Evidence in Public Arena Points

Process by which patients take their medications as prescribed

What is medication adherence ?

The duration of time from initiation to discontinuation of a medication

What is medication persistence?

Direct measurement

• we watch them take it/record

  • Directly observed therapy

  • Therapeutic Drug Monitoring

Indirect measurement

• assume the infection.adherence to medication

How do we measure medication adherence?

• pill count

• self reported measures

• electric monitoring systems

• Administrative data

What are some “indirect measures” of assessing med adherence?

• Proportion of days covered (PDC)

• Medication possession ratio (MDR)

What are the two portions that make up Administrative Data (indirect measurement)?

The number of days covered by medication / total days in period x 100

• accounts for early refills by shifting them forward (ensuring a day is only counted once)

What is proportion of days covered (relating to Admin data- indirect med adherence)?

The SUM of day supply / total days in period x 100

• simply adds up all days dispensed, even if they overlap with previous refill

What is medication possession ratio (MPR) - (relating to Admin data- indirect med adherence)?

• it measures medication possession and NOT adherence to(if they got the refills, not if they used the pills)

• Retrospective analysis

• Doesn’t ensure actual intake of meds by patients

• surrogate measure

What are limitations of using Administrative data to assess patient medication use?

The threshold used to classify patients as non adherent vs adherent ?

PDC = (number of days in period “covered”) / Number of days in period

• Non-adherent PDC < 80%

• Adherent PDC > 80%

What is the PDC?

If patients Medication adherence (PDC) is > 80% in last 91 days:

• the plan sponsor receives a financial incentive

  • Diabetes meds (All classes except GLP and insulin)

  • HTN meds (ACE/ARBs..)

  • Statins

What is an example of value based payment models that inspire providers to encouraged med adherence?