Pharmacy fill data were extracted for the 2002 calendar year and included a listing of all antihypertensive prescriptions filled, the date filled, generic and brand names of the drugs, and number of pills dispensed. Three measures of adherence were calculated: continuous single-interval medication availability (CSA), medication possession ratio (MPR), and continuous multiple-interval medication gaps (CMG) [17 (link),18 (link)]. CSA was calculated by dividing the days’ supply obtained at a pharmacy fill by the number of days before the next pharmacy fill for that same medication. MPR was calculated as the sum of the days’ supply obtained between the first pharmacy fill and the last fill (supply obtained in the last fill was excluded) divided by the total number of days in this time period. CMG was calculated by dividing the total number of days without medications (i.e. treatment gaps) between the first and last pharmacy fill by the number of days in this time period. A graphical example of how CSA, MPR, CMG were calculated is provided in the Appendix.
For every participant, CSA was calculated for each pharmacy fill interval and MPR and CMG scores were calculated by class of antihypertensive medication being taken CSA and MPR values greater than one were truncated at the maximum value of one [19 (link)]. Given self-reported adherence reflects adherence to participants’ antihypertensive medication regimen, one CSA was assigned to each participant based on the mean of all CSAs calculated from all of their antihypertensive pharmacy fill intervals. One MPR and one CMG were assigned to each participant. For participants filling more than one class of antihypertensive medication, MPR and CMG were calculated for each class and then averaged across all classes to assign a single MPR and CMG to each participant. Given that a cut point of 0.8 has been previously used to define adequate medication adherence using pharmacy data [19 (link)-22 (link)] pharmacy fill nonpersistency was defined as <0.8 for CSA and MPR and >0.2 for CMG. Although other studies have reported continuous single interval gaps (CSG), this statistic is the inverse of CSA and, therefore, is not presented.