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- W4233313612 abstract "Low adherence to medication in chronic disease patients leads to increased morbidity, mortality, and healthcare costs. The widespread adoption of electronic prescription and dispensation records allows a more comprehensive overview of medication utilization. In combination with electronic health records (EHR), such data provides new opportunities for identifying patients at risk of nonadherence and provide more targeted and effective interventions. The purpose of this article is to study the predictability of medication adherence for a cohort of hypertensive patients, focusing on healthcare utilization factors under various predictive scenarios. Furthermore, we discover common proportion of days covered patterns (PDC-patterns) for patients with index prescriptions and simulate medication-taking behaviours that might explain observed patterns.We predict refill adherence focusing on factors of healthcare utilization, such as visits, prescription information and demographics of patient and prescriber. We train models with machine learning algorithms, using four different data splits: stratified random, patient, temporal forward prediction with and without index patients. We extract frequent, two-year long PDC-patterns using K-means clustering and investigate five simple models of medication-taking that can generate such PDC-patterns.Model performance varies between data splits (AUC test set: 0.77–0.89). Including historical information increases the performance slightly in most cases (approx. 1–2% absolute AUC uplift). Models show low predictive performance (AUC test set: 0.56–0.66) on index-prescriptions and patients with sudden drops in PDC (Recall: 0.58–0.63). We find 21 distinct two-year PDC-patterns, ranging from good adherence to intermittent gaps and early discontinuation in the first or second year. Simulations show that observed PDC-patterns can only be explained by specific medication consumption behaviours.Prediction models developed using EHR exhibit bias towards patients with high healthcare utilization. Even though actual medication-taking is not observable, consumption patterns may not be as arbitrary, provided that medication refilling and consumption is linked." @default.
- W4233313612 created "2022-05-12" @default.
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- W4233313612 date "1853-12-01" @default.
- W4233313612 modified "2023-09-28" @default.
- W4233313612 title "Address delivered at the close of the twenty-third exhibition of American Manufacturers, held by the Franklin Institute of the State of Pennsylvania, for the promotion of the mechanic arts, from October 18th to November 3d, 1853" @default.
- W4233313612 doi "https://doi.org/10.1016/0016-0032(53)91212-5" @default.
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