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Abstract
Objective The use of retail purchasing data may improve adherence prediction over approaches using healthcare insurance claims alone.
Design Retrospective.
Setting and participants A cohort of patients who received prescription medication benefits through CVS Caremark, used a CVS Pharmacy ExtraCare Health Care (ECHC) loyalty card, and initiated a statin medication in 2011.
Outcome We evaluated associations between retail purchasing patterns and optimal adherence to statins in the 12 subsequent months.
Results Among 11 010 statin initiators, 43% were optimally adherent at 12 months of follow-up. Greater numbers of store visits per month and dollar amount per visit were positively associated with optimal adherence, as was making a purchase on the same day as filling a prescription (p<0.0001 for all). Models to predict adherence using retail purchase variables had low discriminative ability (C-statistic: 0.563), while models with both clinical and retail purchase variables achieved a C-statistic of 0.617.
Conclusions While the use of retail purchases may improve the discriminative ability of claims-based approaches, these data alone appear inadequate for adherence prediction, even with the addition of more complex analytical approaches. Nevertheless, associations between retail purchasing behaviours and adherence could inform the development of quality improvement interventions.
- CLINICAL PHARMACOLOGY
- EPIDEMIOLOGY
- PUBLIC HEALTH
- STATISTICS & RESEARCH METHODS
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Footnotes
Contributors All authors had access to study results and contributed meaningfully to the analysis. AAK, NKC, GS-G and JMF contributed to the study conception and design, interpretation of results, and manuscript drafting. GB prepared and analysed the data. DLI, WHS, TAB and OSM provided interpretation of results and critical manuscript revisions.
Funding This work was supported by an unrestricted grant from CVS Health to Brigham and Women's Hospital. All data analyses and outcomes assessment were performed independently of the study sponsor. WHS, TAB and OSM are employees of CVS Health and own stock in the company.
Competing interests TAB, OSM and WHS are employees of CVS Health and own stock options in the company.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Technical appendix, study protocol and statistical code available from researchers on request.