Measuring Adherence to Chronic Disease Treatment

Using Dispensing Data: An Example from Thailand

Sauwakon Ratanawijitrasin, PhDSanita Hirunrassamee, PhD

Why?

I. E-dispensing data are routinely collected by health facilities.

II. Use of e-dispensing database allows routine adherence monitoring guide interventions for improving use of medicines.

III. Data pool, if available, allows routine population level monitoring.

IV. Quality indicators performance evaluation

Objectives

o To demonstrate the use of e-dispensing database collected by health facilities to monitor adherence in long term care

o To identify technical and contextual challenges

Applicability

o Medicines with high specificity for selected illness conditions

Specificity level

HIV HDM HHypertension LGlaucoma HOsteoporosis HEpilepsy M

Patient selectionDISPENSING DATABASE

SPmed

NonSP

Med

Med use

ICD-10 DATABASE

ICD-10 +med use

Spmed

NonSpMed

ICD-10 +med use

Spmed

Na.valpoate inj.PhenytoinPhenobarbitalLevtiracepam

Migraine drug

TopiramateSod. Valpoate oral form

Psychotic drug

LamotrigineSod. Valpoate oral form

Neuropathic pain drug

GabapentinOxcarbazepineCarbamazepine

Antiepileptic Drug

SPECIFIC MEDICINE

HIV drug

Antiviral for Hep. B

Lamivudine 100 mg

150 mg

ABACAVIR

ATAZANAVIR

DIDANOSINE

EFAVIRENZ

INDINAVIR

LOPINAVIR

RITONAVIR

NELFINAVIR

NEVIRAPINE

SAQUINAVIR

STAVUDINE

TENOFOVIR

ZIDOVUDINE

SPECIFIC MEDICINE

# of patients identified by ….

NO.OF PT. ICD-10

Pt from ICD-10 (using med.)

Disp. Database

HIV 1,695 993 1,604

DM 21,100 10,747 13,917

Glaucoma 5,519 2,587 3,095

Epilepsy 2,149 1,136 6,533

Company Logo

% Day Coverage of HIV patients 24 month TIME TO DISCONTINUATION

Patient group

Individual patientMEDICATION COVERAGE WITH OVERLAPPING DAYS SUPPLY

28-12-07 to 16-05-08

Claim 1 Day 1-30

Claim 2 Day 31-60

Claim 3 Day61-90

Claim 4 Day91-120

Claim 5 Day121-150

Claim 6 Day151-180

Day 1-30 31-60 61-90 91-120 121-150 151-180

25-01-08 to 23-02-08

25-02-08 to 26-03-08

21-03-08-19-04-08

21-04-08 to 20-05-08

16-05-08 to 14-06-08

Study Period Begins28-12-07

Study Period Ends16-05-08

overlap

28-12-07 to 26-01-08

overlap

overlap

DATA POOL: no interhospital data pool

APPOINTMENT DATA: not integrated

DRUG CODE: diff codes for diff systems

DOSAGE DATA: might not be available

ICD-10 DATA: incomplete

CHALLENGEs

MEDICAL SHOPPING TREATMENT CHANGE