Measurement of Completeness and Timeliness of Linked Electronic Health Record Pharmacy Data for Early Detection of Nonadherence to Breast Cancer Adjuvant Endocrine Therapy.

Abstract

Purpose: This retrospective cohort study evaluated whether linked electronic health record (EHR) pharmacy data were adequately complete and timely to detect primary nonadherence to breast cancer adjuvant endocrine therapy (AET).

Materials and methods: Linked EHR pharmacy data were extracted from the EHR for patients with stage 0 to III breast cancer who had their first prescription order for AET between 2016 and 2021. Patients with the first dispense event within 90 days of the prescription were classified as having sufficient or insufficient data available for early detection of primary adherence.

Results: A total of 1,446 eligible patients had a first AET prescription order between 2016 and 2021; these orders were routed to 871 unique pharmacies, of which 856 (98.2%) were contracted with the linked EHR pharmacy database and 15 (1.8%) were not contracted. Among the 1,428 patients with a first prescription sent to a contract pharmacy, 164 (13%) had incomplete linked EHR pharmacy data refresh events to assess primary adherence. Among the 1,244 patients with at least 1 refresh event after their first prescription, 82% occurred within 90 days and were sufficiently timely for early detection of primary adherence. Overall, 32% of patients would benefit from an intervention to verify or improve primary adherence to AET.

Conclusion: Although linked EHR pharmacy data have adequate completeness of contract pharmacy data, local configurations of data refresh events tailored to medication reconciliation workflows are incomplete (13%) and insufficiently timely (32%) to fully support clinical decision support (CDS) for early detection of primary medication nonadherence. Prospective CDS interventions using linked EHR pharmacy data are possible with enhancements to the frequency and timeliness of refresh events.