Understanding Temporal Patterns in Hypertensive Drug Therapy

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1 Understanding Temporal Patterns in Hypertensive Drug Therapy 1 Margret Bjarnadottir, 2 Sana Malik, 2 Catherine Plaisant, 3 Eberechukwu Onukwugha 1 Smith School of Business, University of Maryland, College Park 2 Department of Computer Science, University of Maryland, College Park 3 School of Pharmacy, University of Maryland, Baltimore May 28, 2015 HCIL 32 nd Annual Symposium

2 Worsened conditions Adverse outcomes Increased risk of death 2

3 Hospitalization costs due to medication non-adherence are estimated as high as $13 billion annually. Sullivan et al., Noncompliance with medication regimens and subsequent hospitalizations: a literature analysis and cost of hospitalization estimate, Journal of Research in Pharmaceutical Economics, Vol. 2, No. 2. (1990), pp

4 Medication Possession Ratio (MPR) days supplied length of observation period 4

5 Medication Possession Ratio (MPR) days supplied length of observation period Study start Study end time 4

6 Medication Possession Ratio (MPR) days supplied length of observation period = 100% Study start Study end time 4

7 Medication Possession Ratio (MPR) days supplied length of observation period = 83% Study start Study end time 4

8 Medication Possession Ratio (MPR) days supplied = 75% length of observation period Study start Study end time 5

9 Hypertensive Drug Therapy ACE ARB CCB Beta Diur Angiotension-Converting Enzyme-Inhibitors Angiotension II Receptor Blockers Calcium Channel Blockers Beta Blockers Diuretics 6

10 Hypertensive Drug Therapy time

11 Hypertensive Drug Therapy time

12 Hypertensive Drug Therapy time

13 Hypertensive Drug Therapy time

14 Hypertensive Drug Therapy time

15 Hypertensive Drug Therapy time

16 Hypertensive Drug Therapy time

17 Hypertensive Drug Therapy time

18 Hypertensive Drug Therapy time

19 Hypertensive Drug Therapy time

20 Hypertensive Drug Therapy time

21 Hypertensive Drug Therapy time

22 Hypertensive Drug Therapy time

23 Hypertensive Drug Therapy time

24 Hypertensive Drug Therapy time

25 Hypertensive Drug Therapy time

26 Hypertensive Drug Therapy time

27 Hypertensive Drug Therapy time

28 Hypertensive Drug Therapy time

29 Hypertensive Drug Therapy time

30 Hypertensive Drug Therapy time

31 Hypertensive Drug Therapy time

32 Hypertensive Drug Therapy time

33 Hypertensive Drug Therapy time

34 Can we use visualization tools to more accurately understand adherence patterns in hypertensive drug therapy?

35 Research Questions Can we identify good vs. bad patterns? Can we understand patient behavior? 11

36 Data Commercial prescription claims 900,000 individuals (16 million claims) 5 Drug Classes ACE ARB CCB Beta Diur Angiotension-Converting Enzyme-Inhibitors Angiotension II Receptor Blockers Calcium Channel Blockers Beta Blockers Diuretics 12

37 Data Simplification Partitioning Temporal Windowing Interval Merging 13

38 Data Simplification Partitioning Temporal Windowing Interval Merging Dataset 14

39 Data Simplification Partitioning Temporal Windowing Interval Merging Single } 2 Drugs } 3 Drugs } 4 Drugs All 5 14

40 Data Simplification Partitioning Temporal Windowing Interval Merging Start of record time 15

41 Data Simplification Partitioning Temporal Windowing Interval Merging Start of record 2 years time 15

42 Data Simplification Partitioning Temporal Windowing Interval Merging time 16

43 Data Simplification Partitioning Temporal Windowing Interval Merging time 16

44 How do allowable gap and overlap assumptions affect adherence analysis?

45 Sensitivity Analysis: Allowable Gap 0 days 7 days 15 days 30 days 18

46 Sensitivity Analysis: Allowable Gap 0 days 7 days 15 days 30 days 18

47 Sensitivity Analysis: Allowable Gap 0 days 7 days 15 days 30 days 18

48 Sensitivity Analysis: Allowable Gap 0 days 7 days 15 days 30 days 18

49 Sensitivity Analysis: Allowable Overlap 0 days 7 days 15 days 30 days 19

50 Sensitivity Analysis: Allowable Overlap 0 days 7 days 15 days 30 days 19

51 Sensitivity Analysis: Allowable Overlap 0 days 7 days 15 days 30 days 19

52 Sensitivity Analysis: Allowable Overlap 0 days 7 days 15 days 30 days 19

53 ACE Single Drugs ARB CCB Beta Diur 20

54 ACE Single Drugs ARB CCB Beta Diur 20

55 2 Drugs ACE Beta Both 21

56 2 Drugs ACE Beta Both 21

57 2 Drugs ACE Beta Both false overlap 22

58 2 Drugs ACE Beta Both 23

59 2 Drugs ACE Beta Both 24

60 All 5 Drugs 2,200 patients 25

61 All 5 Drugs 2,200 patients 26

62 All 5 Drugs 2,200 patients 26

63 All 5 Drugs 2,200 patients 26

64 All 5 Drugs 2,200 patients 26

65 All 5 Drugs 2,200 patients 27

66 All 5 Drugs 2,200 patients 27

67 ACE Starting on Diuretic 150,000 patients ARB CCB Beta Diur 28

68 ACE Starting on Diuretic 150,000 patients ARB CCB Beta Diur 28

69 ACE Starting on Diuretic 150,000 patients ARB CCB Beta Diur 28

70 Summary Visualization facilitated rapid understanding of complex patient behavior Interactions allow systematic analysis of episode modeling 29

71 Understanding Temporal Patterns in Hypertensive Drug Therapy Sana Malik Thanks to Sophia Wu. Support from the University of Maryland Center for Health-related Informatics and Bioimaging (CHIB). 30

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