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\begin{document}

\title{Evaluation of the effect of methodological assumptions on estimates of
adherence to antipsychotics: a real-world data study}



\author[1]{MARINA FUENTE-MORENO}%
\author[2]{Alexandra Lelia Dima}%
\author[3]{Maria Rubio-Valera}%
\author[4]{Luisa Baladon}%
\author[4]{Victor Chavarria}%
\author[4]{Salvatore Contaldo}%
\author[4]{Carlos Peña-Salazar}%
\author[5]{Vicky Serra-Sutton}%
\author[6]{Patricia Hermida-González }%
\author[6]{Jorge Peláez de Loño }%
\author[6]{Maria Eugènia  Rey Abella}%
\author[3]{Ignacio Aznar-Lou}%
\author[1]{Antoni Serrano-Blanco}%
\affil[1]{Sant Joan de Deu Research Institute}%
\affil[2]{University of Barcelona Faculty of Psychology}%
\affil[3]{Institut de Recerca Sant Joan de Déu}%
\affil[4]{Parc Sanitari Sant Joan de Deu}%
\affil[5]{Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública}%
\affil[6]{CatSalut}%


\vspace{-1em}



  
  \date{May 18, 2024}


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\begin{abstract}
Introduction: This study aimed to assess the frequency of dosing
inconsistencies in prescription data and the effect of four dosing
assumption strategies on adherence estimates for antipsychotic
treatment. Methods: A retrospective cohort, which linked prescription
and dispensing data of adult patients with [?] 1 antipsychotic
prescription between 2015-2016 and followed up until 2019, in Catalonia
(Spain). Four strategies were proposed for selecting the recommended
dosing in overlapping prescription periods for the same patient and
antipsychotic drug: 1) the minimum dosing prescribed; 2) the dose
corresponding to the latest prescription issued, 3) the highest dosing
prescribed, and 4) all doses included in the overlapped period. For each
strategy, one treatment episode per patient was selected and the
Continuous Medication Availability measure was used to assess adherence.
Descriptive statistics were used to describe results by strategy.
Results: Of 277,324 prescriptions included, 76\% overlapped with other
prescriptions (40\% with different recommended dosing instructions). The
number and characteristics of patients and treatment episodes (18,292,
18,303, 18,339, and 18,536, respectively per strategy) were similar
across strategies. Mean adherence was similar between strategies,
ranging from 57-60\%. However, the proportion of patients with adherence
[?] 90\% was lower when selecting all doses (28\%) compared to the other
strategies (35\%). Conclusions: Despite the high prevalence of
overlapping prescriptions, the strategies proposed did not show a major
effect on the adherence estimates for antipsychotic treatment. Taking
into consideration the particularities of antipsychotic prescription
practices, selecting the highest dose in the overlapped period provided
a more accurate adherence estimate.%
\end{abstract}%



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