Understanding Temporal Patterns in Hypertensive Drug Therapy 1 Margret Bjarnadottir, 2 Sana Malik , 2 Catherine Plaisant, 3 Eberechukwu Onukwugha 1 Smith School of Business, University of Maryland, College Park 2 Department of Computer Science, University of Maryland, College Park 3 School of Pharmacy, University of Maryland, Baltimore May 28, 2015 — HCIL 32 nd Annual Symposium
๏ Worsened conditions ๏ Adverse outcomes ๏ Increased risk of death 2
Hospitalization costs due to medication non-adherence are estimated as high as $13 billion annually. Sullivan et al., “Noncompliance with medication regimens and subsequent hospitalizations: a literature analysis and cost of hospitalization estimate,” Journal of Research in Pharmaceutical Economics, Vol. 2, No. 2. (1990), pp. 19-33. 3
Medication Possession Ratio (MPR) days supplied ∑ length of observatio n period 4
Medication Possession Ratio (MPR) days supplied ∑ length of observatio n period time Study ¡end Study ¡start 4
Medication Possession Ratio (MPR) days supplied ∑ = ¡100% length of observatio n period time Study ¡end Study ¡start 4
Medication Possession Ratio (MPR) days supplied ∑ = ¡83% length of observatio n period time Study ¡end Study ¡start 4
Medication Possession Ratio (MPR) days supplied ∑ = ¡75% length of observatio n period time Study ¡end Study ¡start 5
Hypertensive Drug Therapy Angiotension-Converting Enzyme-Inhibitors ACE ARB Angiotension II Receptor Blockers CCB Calcium Channel Blockers Beta Beta Blockers Diur Diuretics 6
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Hypertensive Drug Therapy time
Can we use visualization tools to more accurately understand adherence patterns in hypertensive drug therapy?
Research Questions ๏ Can we identify good vs. bad patterns? ๏ Can we understand patient behavior? 11
Data ๏ Commercial prescription claims ๏ 900,000 individuals (16 million claims) ๏ 5 Drug Classes Angiotension-Converting Enzyme-Inhibitors ACE Angiotension II Receptor Blockers ARB Calcium Channel Blockers CCB Beta Blockers Beta Diuretics Diur 12
Data Simplification ๏ Partitioning ๏ Temporal Windowing ๏ Interval Merging 13
Data Simplification ๏ Partitioning ๏ Temporal Windowing ๏ Interval Merging Dataset 14
Data Simplification — Single ๏ Partitioning } 2 Drugs ๏ Temporal Windowing } ๏ Interval Merging 3 Drugs } 4 Drugs — All 5 14
Data Simplification ๏ Partitioning ๏ Temporal Windowing ๏ Interval Merging time Start ¡of ¡record 15
Data Simplification ๏ Partitioning ๏ Temporal Windowing ๏ Interval Merging time Start ¡of ¡record 2 ¡years 15
Data Simplification ๏ Partitioning ๏ Temporal Windowing ๏ Interval Merging time 16
Data Simplification ๏ Partitioning ๏ Temporal Windowing ๏ Interval Merging time 16
How do allowable gap and overlap assumptions affect adherence analysis?
Sensitivity Analysis: Allowable Gap 0 days 7 days 15 days 30 days 18
Sensitivity Analysis: Allowable Gap 0 days 7 days 15 days 30 days 18
Sensitivity Analysis: Allowable Gap 0 days 7 days 15 days 30 days 18
Sensitivity Analysis: Allowable Gap 0 days 7 days 15 days 30 days 18
Sensitivity Analysis: Allowable Overlap 0 days 7 days 15 days 30 days 19
Sensitivity Analysis: Allowable Overlap 0 days 7 days 15 days 30 days 19
Sensitivity Analysis: Allowable Overlap 0 days 7 days 15 days 30 days 19
Sensitivity Analysis: Allowable Overlap 0 days 7 days 15 days 30 days 19
ACE ARB Single Drugs CCB Beta Diur 20
ACE ARB Single Drugs CCB Beta Diur 20
ACE 2 Drugs Beta Both 21
ACE 2 Drugs Beta Both 21
ACE 2 Drugs Beta Both false overlap 22
ACE 2 Drugs Beta Both 23
ACE 2 Drugs Beta Both 24
All 5 Drugs 2,200 patients 25
All 5 Drugs 2,200 patients 26
All 5 Drugs 2,200 patients 26
All 5 Drugs 2,200 patients 26
All 5 Drugs 2,200 patients 26
All 5 Drugs 2,200 patients 27
All 5 Drugs 2,200 patients 27
ACE ARB Starting on Diuretic CCB Beta 150,000 patients Diur 28
ACE ARB Starting on Diuretic CCB Beta 150,000 patients Diur 28
ACE ARB Starting on Diuretic CCB Beta 150,000 patients Diur 28
Summary ๏ Visualization facilitated rapid understanding of complex patient behavior ๏ Interactions allow systematic analysis of episode modeling 29
Understanding Temporal Patterns in Hypertensive Drug Therapy Sana Malik maliks@cs.umd.edu www.cs.umd.edu/hcil/eventflow Thanks to Sophia Wu. Support from the University of Maryland Center for Health-related Informatics and Bioimaging (CHIB). 30
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