Abstract P1-13-05: Completeness and timeliness of EMR integrated pharmacy dispensing data for early detection of non-adherence to breast cancer adjuvant endocrine therapy
Authors: Levy Mia , Paul Shirlene , Lieberenz Jordan 
Published: March 2022

Background: Adjuvant endocrine therapy (AET) significantly improves long-term survival of breast cancer patients with hormone receptor-positive disease. Despite the proven clinical efficacy of AET, many breast cancer survivors either fail to fill their first medication order (primary non-adherence), fail to refill their AET at the prescribed frequency (inadequate adherence), or discontinue therapy early (non-persistence), increasing their risk of death from recurrence. Unfortunately, there is no systematic way whereby oncology providers are notified when their patients do not initially fill or refill their AET prescriptions at the prescribed frequency. EMR integrated pharmacy dispensing data (EIPDD) bridges the gap between pharmacies, clinicians, and patients by providing medication dispensing tracking in the electronic health record. EIPDD could be used to identify and address the documentation and notification gaps with the goal of improving adherence and persistence to AET. This study seeks to evaluate the completeness and timeliness of EIPDD for early detection of primary medication non-adherence events to breast cancer adjuvant endocrine therapy. Materials and Methods: Data was extracted from the Epic EMR of an urban academic medical center for patients with documented Stage 0-III breast cancer with first prescription from a breast oncologist for AET between 2016-2019. Surescripts was used as the EIPDD data source integrated into the local Epic EMR. Patients were classified as having sufficient or insufficient data available based on the pharmacy dispense refresh event occurring within 365 days of AET order. The early detection of primary medication adherence was defined as the first dispense event completed within 90 days of first prescription. Primary non-adherence was defined as the failure to have the prescription for AET dispense event within 90 days of first prescription. Patients whose orders were not sent to an EIPDD contracted pharmacy (non-contract pharmacy) were excluded from the primary adherence evaluation and deemed to have incomplete data. Results: Detailed results are shown in the table, but in summary, 963 patients with stage 0-III breast cancer had 963 first prescription orders for AET between 2016-2019 routed to 646 unique pharmacies of which 634(98%) were contract and 12(2%) were non-contract pharmacies. Among the 948 patients with a first prescription sent to a contract pharmacy, 113(11.9%) had incomplete EIPDD refresh events to assess primary adherence. Among the 835 patients with at least one EIPDD refresh event following their first prescription, 80% of those events occurred within 90 days of the first prescription order, sufficiently timely for early detection of primary adherence. However, among those with primary non-adherence, only 4% had EIPDD refresh events within 90 days. Overall, 33.5% of patients would benefit from an intervention to verify or improve primary adherence to AET. Conclusions: EIPDD presents an opportunity to improve provider awareness of AET primary medication adherence. While the frequency of refreshing data could be improved to support more timely and complete data, EIPDD data represents a promising opportunity to provide clinical decision support to breast cancer survivorship teams with the goal of improving primary adherence to AET.

Primary Medication Adherence and Timeliness for Early DetectionCategoryCountPercentageStage 0-III breast cancer 1st prescribed AET by breast provider 2016 -2019963100%Prescription sent to non-contract pharmacy151.5%Prescription sent to contract pharmacy94898.5%Failure to have pharmacy dispense data refresh event within 365 days of AET order11311.9%At least one pharmacy dispense data refresh event within 365 days of AET order83588.1%No AET dispense event within 90 days of prescription order16820.1%Non-primary adherence adequate early detection74.2%Non-primary adherence inadequate early detection16195.8%At least one AET dispense event within 90 days of prescription order (primary medication adherence)66779.9%Primary adherence adequate early detection53279.7%Primary adherence inadequate early detection13520.3%

Citation Format: Mia Levy, Shirlene Paul, Jordan Lieberenz. Completeness and timeliness of EMR integrated pharmacy dispensing data for early detection of non-adherence to breast cancer adjuvant endocrine therapy [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-13-05.