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Pitfalls of medication adherence approximation through EHR and pharmacy records: Definitions, data and computation
Högskolan i Halmstad, Akademin för informationsteknologi, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR Centrum för tillämpade intelligenta system (IS-lab).ORCID-id: 0000-0002-7453-9186
Högskolan i Halmstad, Akademin för informationsteknologi, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR Centrum för tillämpade intelligenta system (IS-lab).ORCID-id: 0000-0002-7796-5201
Högskolan i Halmstad, Akademin för informationsteknologi, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR Centrum för tillämpade intelligenta system (IS-lab).ORCID-id: 0000-0002-3495-2961
Lund University, Lund, Sweden.ORCID-id: 0000-0003-1145-4297
Visa övriga samt affilieringar
2020 (Engelska)Ingår i: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 136, artikel-id 104092Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background and purpose: Patients’ adherence to medication is a complex, multidimensional phenomenon. Dispensation data and electronic health records are used to approximate medication-taking through refill adherence. In-depth discussions on the adverse effects of data quality and computational differences are rare. The purpose of this article is to evaluate the impact of common pitfalls when computing medication adherence using electronic health records.

Procedures: We point out common pitfalls associated with the data and operationalization of adherence measures. We provide operational definitions of refill adherence and conduct experiments to determine the effect of the pitfalls on adherence estimations. We performed statistical significance testing on the impact of common pitfalls using a baseline scenario as reference.

Findings: Slight changes in definition can significantly skew refill adherence estimates. Pickup patterns cause significant disagreement between measures and the commonly used proportion of days covered. Common data related issues had a small but statistically significant (p < 0.05) impact on population-level and significant effect on individual cases.

Conclusion: Data-related issues encountered in real-world administrative databases, which affect various operational definitions of refill adherence differently, can significantly skew refill adherence values, leading to false conclusions about adherence, particularly when estimating adherence for individuals. © 2020 The Authors. Published by Elsevier B.V. 

Ort, förlag, år, upplaga, sidor
Shannon: Elsevier, 2020. Vol. 136, artikel-id 104092
Nyckelord [en]
Medication refill adherence, Electronic health records, Data quality, Pitfalls
Nationell ämneskategori
Annan medicinteknik
Identifikatorer
URN: urn:nbn:se:hh:diva-41712DOI: 10.1016/j.ijmedinf.2020.104092PubMedID: 32062562Scopus ID: 2-s2.0-85079281579OAI: oai:DiVA.org:hh-41712DiVA, id: diva2:1396244
Ingår i projekt
iMedA: Improving MEDication Adherence through Person Centered Care and Adaptive Interventions, Vinnova
Forskningsfinansiär
Vinnova, 2017-04617
Anmärkning

Other funding: Health Technology Center and CAISR at Halmstad University and Halland's Hospital

Tillgänglig från: 2020-02-25 Skapad: 2020-02-25 Senast uppdaterad: 2023-11-29Bibliografiskt granskad
Ingår i avhandling
1. Data-driven personalized healthcare: Towards personalized interventions via reinforcement learning for Mobile Health
Öppna denna publikation i ny flik eller fönster >>Data-driven personalized healthcare: Towards personalized interventions via reinforcement learning for Mobile Health
2021 (Engelska)Licentiatavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Medical and technological advancement in the last century has led to the unprecedented increase of the populace's quality of life and lifespan. As a result, an ever-increasing number of people live with chronic health conditions that require long-term treatment, resulting in increased healthcare costs and managerial burden to the healthcare provider. This increase in complexity can lead to ineffective decision-making and reduce care quality for the individual while increasing costs. One promising direction to tackle these issues is the active involvement of the patient in managing their care. Particularly for chronic diseases, where ongoing support is often required, patients must understand their illness and be empowered to manage their care. With the advent of smart devices such as smartphones, it is easier than ever to provide personalised digital interventions to patients, help them manage their treatment in their daily lives, and raise awareness about their illness. If such new approaches are to succeed, scalability is necessary, and solutions are needed that can act autonomously without costly human intervention. Furthermore, solutions should exhibit adaptability to the changing circumstances of an individual patient's health, needs and goals. Through the ongoing digitisation of healthcare, we are presented with the unique opportunity to develop cost-effective and scalable solutions through Artificial Intelligence (AI).

This thesis presents work that we conducted as part of the project improving Medication Adherence through Person-Centered Care and Adaptive Interventions (iMedA) that aims to provide personalised adaptive interventions to hypertensive patients, supporting them in managing their medication regiment. The focus lies on inadequate medication adherence (MA), a pervasive issue where patients do not take their medication as instructed by their physician. The selection of individuals for intervention through secondary database analysis on Electronic Health Records (EHRs) was a key challenge and is addressed through in-depth analysis of common adherence measures, development of prediction models for MA and discussions on limitations of such approaches for analysing MA. Furthermore, providing personalised adaptive interventions is framed in the contextual bandit setting and addresses the challenge of delivering relevant interventions in environments where contextual information is significantly corrupted.       

The contributions of the thesis can be summarised as follows: (1) Highlighting the issues encountered in measuring MA through secondary database analysis and providing recommendations to address these issues, (2) Investigating machine learning models developed using EHRs for MA prediction and extraction of common refilling patterns through EHRs and (3) formal problem definition for a novel contextual bandit setting with context uncertainty commonly encountered in Mobile Health and development of an algorithm designed for such environments.  

Ort, förlag, år, upplaga, sidor
Halmstad: Halmstad University Press, 2021. s. 55
Serie
Halmstad University Dissertations ; 79
Nyckelord
Information Driven Care, Electronic Health Records, Machine Learning, Reinforcement Learning
Nationell ämneskategori
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi Signalbehandling
Identifikatorer
urn:nbn:se:hh:diva-44091 (URN)9789188749666 (ISBN)9789188749673 (ISBN)
Presentation
2021-04-19, Wigforss, Visionen, Kristian IV:s väg 3, Halmstad, 14:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2021-04-08 Skapad: 2021-04-01 Senast uppdaterad: 2022-03-11Bibliografiskt granskad
2. Mobile Health Interventions through Reinforcement Learning
Öppna denna publikation i ny flik eller fönster >>Mobile Health Interventions through Reinforcement Learning
2023 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

This thesis presents work conducted in the domain of sequential decision-making in general and Bandit problems in particular, tackling challenges from a practical and theoretical perspective, framed in the contexts of mobile Health. The early stages of this work have been conducted in the context of the project ``improving Medication Adherence through Person-Centred Care and Adaptive Interventions'' (iMedA) which aims to provide personalized adaptive interventions to hypertensive patients, supporting them in managing their medication regimen. The focus lies on inadequate medication adherence (MA), a pervasive issue where patients do not take their medication as instructed by their physician. The selection of individuals for intervention through secondary database analysis on Electronic Health Records (EHRs) was a key challenge and is addressed through in-depth analysis of common adherence measures, development of prediction models for MA, and discussions on limitations of such approaches for analyzing MA. Providing personalized adaptive interventions is framed in several bandit settings and addresses the challenge of delivering relevant interventions in environments where contextual information is unreliable and full of noise. Furthermore, the need for good initial policies is explored and improved in the latent-bandits setting, utilizing prior collected data to optimal selection the best intervention at every decision point. As the final concluding work, this thesis elaborates on the need for privacy and explores different privatization techniques in the form of noise-additive strategies using a realistic recommendation scenario.         

The contributions of the thesis can be summarised as follows: (1) Highlighting the issues encountered in measuring MA through secondary database analysis and providing recommendations to address these issues, (2) Investigating machine learning models developed using EHRs for MA prediction and extraction of common refilling patterns through EHRs, (3) formal problem definition for a novel contextual bandit setting with context uncertainty commonly encountered in Mobile Health and development of an algorithm designed for such environments. (4) Algorithmic improvements, equipping the agent with information-gathering capabilities for active action selection in the latent bandit setting, and (5) exploring important privacy aspects using a realistic recommender scenario.   

Ort, förlag, år, upplaga, sidor
Halmstad: Halmstad University Press, 2023. s. 56
Serie
Halmstad University Dissertations ; 102
Nationell ämneskategori
Datavetenskap (datalogi)
Forskningsämne
Hälsoinnovation, Informationsdriven vård
Identifikatorer
urn:nbn:se:hh:diva-52139 (URN)978-91-89587-17-5 (ISBN)978-91-89587-16-8 (ISBN)
Disputation
2023-12-15, S1002, Kristian IV:s väg 3, Halmstad, 13:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2023-11-29 Skapad: 2023-11-29 Senast uppdaterad: 2024-01-03Bibliografiskt granskad

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Galozy, AlexanderNowaczyk, SławomirPinheiro Sant'Anna, AnitaOhlsson, Mattias

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