Factors associated with physicians’ prescriptions for rheumatoid arthritis drugs not filled by patients

Abstract Background This study estimated the extent and predictors of primary nonadherence (i.e., prescriptions made by physicians but not initiated by patients) to methotrexate and to biologics or tofacitinib in rheumatoid arthritis (RA) patients who were newly prescribed these medications. Methods...

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Main Authors: Hong J. Kan, Kirill Dyagilev, Peter Schulam, Suchi Saria, Hadi Kharrazi, David Bodycombe, Charles T. Molta, Jeffrey R. Curtis
Format: Article
Language:English
Published: BMC 2018-05-01
Series:Arthritis Research & Therapy
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13075-018-1580-5
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spelling doaj-a956dbfba0914a4ea36cdc2637bd19ff2020-11-24T20:58:33ZengBMCArthritis Research & Therapy1478-63622018-05-0120111210.1186/s13075-018-1580-5Factors associated with physicians’ prescriptions for rheumatoid arthritis drugs not filled by patientsHong J. Kan0Kirill DyagilevPeter Schulam1Suchi Saria2Hadi Kharrazi3David Bodycombe4Charles T. Molta5Jeffrey R. Curtis6Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public HealthComputer Science Department, Johns Hopkins UniversityComputer Science Department, Johns Hopkins UniversityCenter for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public HealthCenter for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public HealthMain Line Rheumatology, Lankenau Medical CenterDivision of Clinical Immunology and Rheumatology, University of Alabama at BirminghamAbstract Background This study estimated the extent and predictors of primary nonadherence (i.e., prescriptions made by physicians but not initiated by patients) to methotrexate and to biologics or tofacitinib in rheumatoid arthritis (RA) patients who were newly prescribed these medications. Methods Using administrative claims linked with electronic health records (EHRs) from multiple healthcare provider organizations in the USA, RA patients who received a new prescription for methotrexate or biologics/tofacitinib were identified from EHRs. Claims data were used to ascertain filling or administration status. A logistic regression model for predicting primary nonadherence was developed and tested in training and test samples. Predictors were selected based on clinical judgment and LASSO logistic regression. Results A total of 36.8% of patients newly prescribed methotrexate failed to initiate methotrexate within 2 months; 40.6% of patients newly prescribed biologics/tofacitinib failed to initiate within 3 months. Factors associated with methotrexate primary nonadherence included age, race, region, body mass index, count of active drug ingredients, and certain previously diagnosed and treated conditions at baseline. Factors associated with biologics/tofacitinib primary nonadherence included age, insurance, and certain previously treated conditions at baseline. The area under the receiver operating characteristic curve of the logistic regression model estimated in the training sample and applied to the independent test sample was 0.86 and 0.78 for predicting primary nonadherence to methotrexate and to biologics/tofacitinib, respectively. Conclusions This study confirmed that failure to initiate new prescriptions for methotrexate and biologics/tofacitinib was common in RA patients. It is feasible to predict patients at high risk of primary nonadherence to methotrexate and to biologics/tofacitinib and to target such patients for early interventions to promote adherence.http://link.springer.com/article/10.1186/s13075-018-1580-5Rheumatoid arthritisPrimary nonadherenceDisease-modifying anti-rheumatic drugsMethotrexateBiologicsPredictive modeling
collection DOAJ
language English
format Article
sources DOAJ
author Hong J. Kan
Kirill Dyagilev
Peter Schulam
Suchi Saria
Hadi Kharrazi
David Bodycombe
Charles T. Molta
Jeffrey R. Curtis
spellingShingle Hong J. Kan
Kirill Dyagilev
Peter Schulam
Suchi Saria
Hadi Kharrazi
David Bodycombe
Charles T. Molta
Jeffrey R. Curtis
Factors associated with physicians’ prescriptions for rheumatoid arthritis drugs not filled by patients
Arthritis Research & Therapy
Rheumatoid arthritis
Primary nonadherence
Disease-modifying anti-rheumatic drugs
Methotrexate
Biologics
Predictive modeling
author_facet Hong J. Kan
Kirill Dyagilev
Peter Schulam
Suchi Saria
Hadi Kharrazi
David Bodycombe
Charles T. Molta
Jeffrey R. Curtis
author_sort Hong J. Kan
title Factors associated with physicians’ prescriptions for rheumatoid arthritis drugs not filled by patients
title_short Factors associated with physicians’ prescriptions for rheumatoid arthritis drugs not filled by patients
title_full Factors associated with physicians’ prescriptions for rheumatoid arthritis drugs not filled by patients
title_fullStr Factors associated with physicians’ prescriptions for rheumatoid arthritis drugs not filled by patients
title_full_unstemmed Factors associated with physicians’ prescriptions for rheumatoid arthritis drugs not filled by patients
title_sort factors associated with physicians’ prescriptions for rheumatoid arthritis drugs not filled by patients
publisher BMC
series Arthritis Research & Therapy
issn 1478-6362
publishDate 2018-05-01
description Abstract Background This study estimated the extent and predictors of primary nonadherence (i.e., prescriptions made by physicians but not initiated by patients) to methotrexate and to biologics or tofacitinib in rheumatoid arthritis (RA) patients who were newly prescribed these medications. Methods Using administrative claims linked with electronic health records (EHRs) from multiple healthcare provider organizations in the USA, RA patients who received a new prescription for methotrexate or biologics/tofacitinib were identified from EHRs. Claims data were used to ascertain filling or administration status. A logistic regression model for predicting primary nonadherence was developed and tested in training and test samples. Predictors were selected based on clinical judgment and LASSO logistic regression. Results A total of 36.8% of patients newly prescribed methotrexate failed to initiate methotrexate within 2 months; 40.6% of patients newly prescribed biologics/tofacitinib failed to initiate within 3 months. Factors associated with methotrexate primary nonadherence included age, race, region, body mass index, count of active drug ingredients, and certain previously diagnosed and treated conditions at baseline. Factors associated with biologics/tofacitinib primary nonadherence included age, insurance, and certain previously treated conditions at baseline. The area under the receiver operating characteristic curve of the logistic regression model estimated in the training sample and applied to the independent test sample was 0.86 and 0.78 for predicting primary nonadherence to methotrexate and to biologics/tofacitinib, respectively. Conclusions This study confirmed that failure to initiate new prescriptions for methotrexate and biologics/tofacitinib was common in RA patients. It is feasible to predict patients at high risk of primary nonadherence to methotrexate and to biologics/tofacitinib and to target such patients for early interventions to promote adherence.
topic Rheumatoid arthritis
Primary nonadherence
Disease-modifying anti-rheumatic drugs
Methotrexate
Biologics
Predictive modeling
url http://link.springer.com/article/10.1186/s13075-018-1580-5
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