Adherence to long-term therapies in cystic fibrosis: a French cross-sectional study linking prescribing, dispensing, and hospitalization data
Received 11 April 2019
Accepted for publication 20 July 2019
Published 4 September 2019 Volume 2019:13 Pages 1497—1510
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Melinda Thomas
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
Héloïse Rouzé1,2, Marie Viprey1,2, Samuel Allemann2, Alexandra L Dima2, Pascal Caillet3, Angélique Denis1, Stéphanie Poupon-Bourdy1, Boubou Camara4, Catherine Llerena5, Philippe Reix6, Isabelle Durieu2,7, Quitterie Reynaud2,7, Sandrine Touzet1,2
1Public Health Department, Hospices Civils de Lyon, Lyon, France; 2HESPER Lab-EA 7425, Université de Lyon-Université Claude Bernard Lyon 1, Lyon, France; 3Department of Clinical Pharmacology, CHU de Nantes, Nantes, France; 4Pulmonary Department, Adult CF Center, CHU de Grenoble, Grenoble, France; 5Pediatric Pulmonology Department, Pediatric CF Center, CHU de Grenoble, Grenoble, France; 6Pediatric Pulmonology Department, Pediatric CF Center, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Lyon, France; 7Department of Internal Medicine, Adult Cystic Fibrosis Care Center, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
Correspondence: Héloïse Rouzé
Hospices Civils de Lyon, Pôle de Santé Publique, Bâtiment A, 6ème étage, 162 Avenue Lacassagne 69003 Lyon, France
Tel +33 47 211 5132
Background: Cystic fibrosis (CF) is a life-shortening genetic condition that usually affects several organs and involves significant treatment burden. Adherence to medication is important for successful CF management.
Objective: To describe medication adherence according to age, therapeutic class, and pharmaceutical form in adults and children followed in four regional CF centers in France.
Methods: We conducted a cross-sectional study with non-transplanted patients followed in two adult and two pediatric centers during 2015 who were covered by the French National Health Insurance (NHI). Sociodemographic, clinical, hospitalization, and prescription data were collected from patient medical records. Medication dispensations were extracted from the regional French NHI database. Adherence was calculated over 12 months using continuous medication availability (CMA) accounting for dose adjustments and hospitalizations. Drug-specific CMA was computed in R with the AdhereR package for each medication prescribed more than 3 months, which was averaged to obtain a composite CMA score (cCMA) for all treatments and per therapeutic class as well as pharmaceutical form for each patient.
Results: A total of 228 patients were included. The number of chronic medications increased with age (r=0.50, p<0.001): a median of 7 medications per patient were prescribed. The mean±SD cCMA was significantly different between age groups (p=0.0098): it was 0.71±0.20 for the 0–5 years age group, 0.73±0.16 for 6–11 years, 0.64±0.17 for 12–17 years, 0.57±0.23 for 18–25 years, and 0.65±0.20 for the over 25 years age group. cCMA varied significantly according to pharmaceutical forms: the mean±SD cCMA was 0.70±0.21 for oral medications and 0.54±0.28 for inhaled medications (p<0.001).
Conclusion: This study suggests that adherence to medication regimens in CF patients remains suboptimal and varies substantially between age groups and pharmaceutical forms. These variations in adherence should be considered when developing effective strategies to improve adherence.
Keywords: cystic fibrosis, chronic treatment, medication adherence, administrative claims data, prescription data
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