title: Understanding Adherence and Prescription Patterns Using Large-Scale Claims Data.
abstract: BACKGROUND
  Advanced computing capabilities and novel visual analytics tools now allow us to move beyond the traditional cross-sectional summaries to analyze longitudinal prescription patterns and the impact of study design decisions. For example, design decisions regarding gaps and overlaps in prescription fill data are necessary for measuring adherence using prescription claims data. However, little is known regarding the impact of these decisions on measures of medication possession (e.g., medication possession ratio). The goal of the study was to demonstrate the use of visualization tools for pattern discovery, hypothesis generation, and study design.
  
  
  METHODS
  We utilized EventFlow, a novel discrete event sequence visualization software, to investigate patterns of prescription fills, including gaps and overlaps, utilizing large-scale healthcare claims data. The study analyzes data of individuals who had at least two prescriptions for one of five hypertension medication classes: ACE inhibitors, angiotensin II receptor blockers, beta blockers, calcium channel blockers, and diuretics. We focused on those members initiating therapy with diuretics (19.2%) who may have concurrently or subsequently take drugs in other classes as well. We identified longitudinal patterns in prescription fills for antihypertensive medications, investigated the implications of decisions regarding gap length and overlaps, and examined the impact on the average cost and adherence of the initial treatment episode.
  
  
  RESULTS
  A total of 790,609 individuals are included in the study sample, 19.2% (N = 151,566) of whom started on diuretics first during the study period. The average age was 52.4 years and 53.1% of the population was female. When the allowable gap was zero, 34% of the population had continuous coverage and the average length of continuous coverage was 2 months. In contrast, when the allowable gap was 30 days, 69% of the population showed a single continuous prescription period with an average length of 5 months. The average prescription cost of the period of continuous coverage ranged from US$3.44 (when the maximum gap was 0 day) to US$9.08 (when the maximum gap was 30 days). Results were less impactful when considering overlaps.
  
  
  CONCLUSIONS
  This proof-of-concept study illustrates the use of visual analytics tools in characterizing longitudinal medication possession. We find that prescription patterns and associated prescription costs are more influenced by allowable gap lengths than by definitions and treatment of overlap. Research using medication gaps and overlaps to define medication possession in prescription claims data should pay particular attention to the definition and use of gap lengths.
authors.affiliation: Robert H. Smith School of Business, 4324 Van Munching Hall, College Park, MD, 20742, USA. margret@rhsmith.umd.edu.
authors.forename: Margrét V
authors.initials: MV
authors.lastname: Bjarnadóttir
authors.affiliation: Human-Computer Interaction Lab, University of Maryland, College Park, MD, USA.
authors.forename: Sana
authors.initials: S
authors.lastname: Malik
authors.affiliation: Department of Pharmaceutical Health Services Research, Baltimore, MD, USA.
authors.forename: Eberechukwu
authors.initials: E
authors.lastname: Onukwugha
authors.affiliation: Pharmaceutical Research Computing, Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD, USA.
authors.forename: Tanisha
authors.initials: T
authors.lastname: Gooden
authors.affiliation: Human-Computer Interaction Lab, University of Maryland, College Park, MD, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Plaisant
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000191:economics; D016208:Databases, Factual / Q000706:statistics & numerical data*; D003657:Decision Making; D016527:Drug Costs; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D055553:Prescription Drugs / Q000008:administration & dosage* / Q000191:economics; D012107:Research Design; D012984:Software
chemical_list: D000959:Antihypertensive Agents; D055553:Prescription Drugs