Measuring Adherence to Chronic Disease Treatment Using Dispensing Data: An Example from Thailand Sauwakon Ratanawijitrasin, PhD Sanita Hirunrassamee, PhD

Why? I.E-dispensing data are routinely collected by health facilities. II.Use of e-dispensing database allows routine adherence monitoring  guide interventions for improving use of medicines. III.Data pool, if available, allows routine population level monitoring. IV.Quality indicators  performance evaluation

Objectives o To demonstrate the use of e-dispensing database collected by health facilities to monitor adherence in long term care o To identify technical and contextual challenges o To demonstrate the use of e-dispensing database collected by health facilities to monitor adherence in long term care o To identify technical and contextual challenges Applicability o o Medicines with high specificity for selected illness conditions

Specificity level HIV H DM H Hypertension L Glaucoma H Osteoporosis H Epilepsy M

Patient selection ICD-10 +med use Sp med Non Sp Med ICD-10 +med use Sp med

Na.valpoate inj. Phenytoin Phenobarbital Levtiracepam Migraine drug Topiramate Sod. Valpoate oral form Psychotic drug Lamotrigine Sod. Valpoate oral form Neuropathic pain drug Gabapentin Oxcarbazepine Carbamazepine

HIV drug Antiviral for Hep. B Lamivudine 100 mg 150 mg ABACAVIR ATAZANAVIR DIDANOSINE EFAVIRENZ INDINAVIR LOPINAVIR RITONAVIR NELFINAVIR NEVIRAPINE SAQUINAVIR STAVUDINE TENOFOVIR ZIDOVUDINE

# of patients identified by …. NO.OF PT.ICD-10 Pt from ICD-10 (using med.) Disp. Database HIV1, ,604 DM21,10010,74713,917 Glaucoma5,5192,5873,095 Epilepsy2,1491,1366,533

Company Logo Patient group

DATA POOL: no interhospital data pool APPOINTMENT DATA: not integrated DRUG CODE: diff codes for diff systems DOSAGE DATA: might not be available ICD-10 DATA: incomplete CHALLENGE s MEDICAL SHOPPING TREATMENT CHANGE