title: Application of a framework for determining number of drugs.
abstract: BACKGROUND
  There are many different methodologies used in the literature for determining the number of drugs used by a patient, and many are incompletely described. This may be attributable to the lack of a framework to help investigators choose and describe their methods and the lack of evidence on the implications of the choice. The purpose of the study was to propose a framework and illustrate how that framework can be used to create and succinctly describe various approaches to counting the number of drugs used by patients and to examine the impact of varying individual components of the framework on the resulting drug count.
  
  
  METHODS
  The three component framework requires specification of scope, uniqueness, and timeframe. The framework was applied to Medicare beneficiaries admitted for acute myocardial infarction in 2008. Drug use was ascertained by Part D prescription drug event files. A default measure for drug count was established, and fourteen additional measures were created by separately altering individual components of the default to illustrate the application of the framework and understand how these changes impacted drug count. Median drug counts and the frequency distributions of beneficiaries experiencing a change in count from default were produced for each measure.
  
  
  RESULTS
  The median drug count for the default measure was 4. Alteration of the timeframe component had the largest impact on drug counts, with a look-back period of 180 days producing a median count of 8 and changing the count by at least two for 73 % of patients. Variations of the other components had less impact.
  
  
  CONCLUSIONS
  Our framework is intended to be used by investigators to select an approach to counting number of drugs in their studies. Extending the timeframe over which fills from a pharmacy refill database could be counted toward the drug count produced the greatest changes in the number of drugs.
authors.affiliation: Division of Health Services Research, University of Iowa College of Pharmacy, 115 S. Grand Ave, S557 PHAR, Iowa City, IA, 52242, USA. amber-goedken@uiowa.edu.
authors.forename: Amber M
authors.initials: AM
authors.lastname: Goedken
authors.affiliation: Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.|Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Lund
authors.affiliation: Clinical Trials Statistical and Data Management Center, University of Iowa, Iowa City, IA, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Cook
authors.affiliation: Division of Health Services Research, University of Iowa College of Pharmacy, 115 S. Grand Ave, S557 PHAR, Iowa City, IA, 52242, USA.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Schroeder
authors.affiliation: Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Brooks
mesh_terms: D006801:Humans; D054524:Medicare Part D; D009203:Myocardial Infarction / Q000188:drug therapy*; D019338:Polypharmacy; D014481:United States
keywords: Acute myocardial infarction; Drug count; Framework; Medicare; Pharmacy refill database