2020 Background Medication persistence is important after MI to optimize clinical outcomes Clinical and research efforts variably use patient report and pharmacy fill data to assess persistence ID: 1045053
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1. Fanaroff et al. JAMA Cardiol. 2020
2. BackgroundMedication persistence is important after MI to optimize clinical outcomes Clinical and research efforts variably use patient report and pharmacy fill data to assess persistenceConcordance between measurement methods is unknown
3. ObjectivesThe ARTEMIS trial used several methods to measure persistence with P2Y12 inhibitorDescribe variation in medication persistence rates between measurement methodsExamine concordance/discordance between methodsAssess outcomes associated with discordant and concordant persistence measurements
4. STEMI or NSTEMI patients discharged on P2Y12 inhibitor11,001 MI patients at 301 US hospitalsCopayment Intervention131 sites enrolled 6,135 patientsIntervention site patients were provided a copayment voucher card for either a generic (clopidogrel) or brand (ticagrelor) P2Y12 inhibitor, selected by the treating physicianUsual Care156 sites enrolled 3,967 patientsHospital-level Randomization *Study Design
5. Cohort development
6. DefinitionsPersistence defined as no gap >30 days within 1 year post-discharge Patient report:Interviews every 3 months asked patients to report stop/restart dates if gaps in usePharmacy fill:National pharmacy claims (>80% U.S. pharmacies) tracking dates and quantity filledVoucher use (intervention arm only):Copayment reduction voucher tracked dates and quantity filled covered by the voucherBlood draws performed in a random subset to check serum P2Y12 levels
7. Persistence by Method
8. Discordance between Methods
9. Outcomes by Persistence Status
10. Inaccuracy of Pharmacy FillAmong 3703 intervention arm patients, 1184 (32%) were non-persistent by both voucher use and pharmacy fill (compared with 10% by self-report and 40% by pharmacy fill alone)Of 1487 intervention arm patients non-persistent by pharmacy fill data, 303 (20%) were persistent when voucher data was considered
11. ConclusionsPatient report overestimated medication persistence and pharmacy fill data underestimated medication persistence ratesMore than 1/3 of patients had discordant persistencePatients non-persistent by both methods have the worst clinical outcomes
12. ImplicationsTraditionally, patients have self-reported persistenceHealth systems have incorporated pharmacy fill data into EHRs to enable physicians to identify non-persistence objectivelyWe show that neither patient report nor pharmacy fill alone represent the “truth”Best practice to measure persistence and target interventions to improve it should incorporate both pharmacy fill data and patient report