Johannes Holm

Background: For accurate medication usage statistics and medication adherence calculations, we need to have an accurate days’ supply (DS) for each prescription. Unfortunately, often the DS or the information needed for calculating the DS is not provided. Therefore, other methods need to be applied to acquire missing values or substitute incorrect values. Objective: This study aims to apply a variety of methods for managing incomplete and missing data to enhance the accuracy of calculating DS for all medications and drug forms alike. Furthermore, to describe the effect of applied methods on the medication adherence calculated on real-world data. Methods: A dataset comprising prescription records from a 10% (150,824 patients) random sample of the Estonian population between 2012 and 2019 was used. The workflow consisted of 3 steps: data cleaning, imputation, and calculation of DS. For imputation, different methods were combined, such as calculating mode-based daily dose, or using usage guidelines from the Summary of Product Characteristics or legislation. DS was calculated based on the provided daily dose or imputed value. To evaluate the impact of data cleaning, medication adherence for the baseline dataset and corrected dataset for 2 time periods, 2012-2015 and 2017-2019, was calculated and compared. Results: The drug forms with the lowest proportion of correct DS provided were insulin injections (2601/82,867, 3.1%) and intravaginal contraceptives (1692/21,145, 8%) while the highest proportion of DS was provided for inhalation medication (78,541/126,588, 62%), oral drops (52,085/98,221, 53%) and tablets, capsules, suppositories (2,828,617/6,176,585, 45.8%). As a result of applying different imputation approaches, we successfully found the DS for 98.3% (7,415,347/7,544,892) of dispensed prescriptions. For the remaining 1.7% (129,545/7,544,892) of prescriptions, DS could not be imputed nor calculated with these methods. As for the medication adherence, the distinction between 2 observed time periods was more distinct in the baseline dataset compared with the corrected dataset for most of the drug groups, indicating that the applied correction methods had lessened the stark contrast. Conclusions: In summary, our study demonstrated that with a carefully designed imputation pipeline where data-driven imputation is combined with domain knowledge and literature information, it is possible to meaningfully improve the quality of prescription datasets and generate more accurate and consistent adherence metrics across various drug forms. Nonetheless, future efforts should continue to refine imputation techniques, incorporate machine learning approaches where appropriate, and expand validation efforts using external benchmarks or clinical outcomes.

BACKGROUND For accurate medication usage statistics and medication adherence calculations, we need to have an accurate days’ supply (DS) for each prescription. Unfortunately, often the DS or the information needed for calculating the DS is not provided. Therefore, other methods need to be applied to acquire missing values or substitute incorrect values. OBJECTIVE This study aims to apply a variety of methods for managing incomplete and missing data to enhance the accuracy of calculating DS for all medications and drug forms alike. Furthermore, to describe the effect of applied methods on the medication adherence calculated on real-world data. METHODS A dataset comprising prescription records from a 10% (150,824 patients) random sample of the Estonian population between 2012 and 2019 was used. The workflow consisted of 3 steps: data cleaning, imputation, and calculation of DS. For imputation, different methods were combined, such as calculating mode-based daily dose, or using usage guidelines from the Summary of Product Characteristics or legislation. DS was calculated based on the provided daily dose or imputed value. To evaluate the impact of data cleaning, medication adherence for the baseline dataset and corrected dataset for 2 time periods, 2012-2015 and 2017-2019, was calculated and compared. RESULTS The drug forms with the lowest proportion of correct DS provided were insulin injections (2601/82,867, 3.1%) and intravaginal contraceptives (1692/21,145, 8%) while the highest proportion of DS was provided for inhalation medication (78,541/126,588, 62%), oral drops (52,085/98,221, 53%) and tablets, capsules, suppositories (2,828,617/6,176,585, 45.8%). As a result of applying different imputation approaches, we successfully found the DS for 98.3% (7,415,347/7,544,892) of dispensed prescriptions. For the remaining 1.7% (129,545/7,544,892) of prescriptions, DS could not be imputed nor calculated with these methods. As for the medication adherence, the distinction between 2 observed time periods was more distinct in the baseline dataset compared with the corrected dataset for most of the drug groups, indicating that the applied correction methods had lessened the stark contrast. CONCLUSIONS In summary, our study demonstrated that with a carefully designed imputation pipeline where data-driven imputation is combined with domain knowledge and literature information, it is possible to meaningfully improve the quality of prescription datasets and generate more accurate and consistent adherence metrics across various drug forms. Nonetheless, future efforts should continue to refine imputation techniques, incorporate machine learning approaches where appropriate, and expand validation efforts using external benchmarks or clinical outcomes.