Assessing the population-level correlation of medication regimen complexity and adherence indices using electronic health records and insurance claims

BACKGROUND: Nonadherence to medication regimens can lead to adverse health care outcomes and increasing costs. OBJECTIVES: To (a) assess the level of medication complexity at an outpatient setting using population-level electronic health record (EHR) data and (b) evaluate its association with medication adherence measures derived from medication-dispensing claims. METHODS: We linked EHR data with insurance claims of 70,054 patients who had an encounter with a U.S. midwestern health system between 2012 and 2013. We constructed 3 medication-derived indices: medication regimen complexity index (MRCI) using EHR data; medication possession ratio (MPR) using insurance pharmacy claims; and prescription fill rates (PFR; 7 and 30 days) using both data sources. We estimated the partial correlation between indices using Spearman's coefficient (SC) after adjusting for age and sex. RESULTS: The mean age (SD) of 70,054 patients was 37.9 (18.0) years, with an average Charlson Comorbidity Index of 0.308 (0.778). The 2012 data showed mean (SD) MRCI, MPR, and 30-day PFR of 14.6 (17.8), 0.624 (0.310), and 81.0 (27.0), respectively. Patients with previous inpatient stays were likely to have high MRCI scores (36.3 [37.9], P<0.001) and were less adherent to outpatient prescriptions (MPR=50.3 [27.6%], P<0.001; 30-day PFR=75.7 [23.6%], P<0.001). However, MRCI did not show a negative correlation with MPR (SC=−0.31, P<0.001) or with 30-day PFR (SC=−0.17, P<0.001) at significant levels. CONCLUSIONS: Medication complexity and adherence indices can be calculated on a population level using linked EHR and claims data. Regimen complexity affects patient adherence to outpatient medication, and strength of correlations vary modestly across populations. Future studies should assess the added values of MRCI, MPR, and PFR to population health management efforts.