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  1. FHIR Specification Feedback
  2. FHIR-43757

Value set for medication adherence extension is unclear

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Core (FHIR)
    • 7.0.0-ballot
    • Cross-Group Projects
    • STU
    • US Core Medication Adherence Extension
      US Core MedicationRequest Profile
    • 13.136.1.2,13.168.1
    • Hide
      1. Remove 457831000124109, 275928001, 275927006 and add 715036001
      2. Add Profile Specific Implementation Guidance to the extension to supplying some US Core definition to this starter set of codes.

      Note that this valueset is extensible, it is comprised of a set of basic Medication Adherence SNOMED CT and NullValue codes. More specific codes or other codes can be used from SNOMED CT or other code system including local codes. Refer to the section on Extensible Bindings

      Rank Code (SCT ID) Preferred Term US Core Definition
      0 1156699004 Complies with drug therapy (finding) The medication is being taken as directed.
      0 702565001 Non-compliance of drug therapy (finding) The medication is being taken, but not as directed.( e.g., occasionaly forgets to take or 2 pills instead of 3))
      1 275928001 Drugs - partial non-compliance (finding)  
      1 275927006 Drugs - total non-compliance (finding)  
      0 457831000124109 Medication therapy compliance variable (finding)  
      0 715036001 Does not take medication (finding) The medication is not being taken

      Armed with these definitions, we can map these scenarios from the tracker:

      -Patient is supposed to take 30 mg twice daily and has reported they're only taking their morning dose -> 702565001

      -Patient is supposed to take 30 mg twice daily and has reported they're taking 20 mg twice daily zc -> 702565001

      -Patient is supposed to take 30 mg twice daily. They are following the prescribed instructions, but data from a pill tracker indicates they're regularly forgetting doses. -> 702565001

      -Patient is supposed to take 30 mg twice daily. They are very compliant when they have supply, but can't always afford to refill the medication on time. -> 702565001 

      -Patient received adherence coaching a few months ago and is currently complying with their medications. Their PDC score for the year hasn't fully caught up and is under 50%. -> 1156699004 ? require clinical interpretation which outside the scope of US Core.

      Show
      Remove 457831000124109, 275928001, 275927006 and add 715036001 Add  Profile Specific Implementation Guidance  to the extension to supplying some US Core definition to this starter set of codes. Note that this valueset is extensible, it is comprised of a set of basic Medication Adherence SNOMED CT and NullValue codes. More specific codes or other codes can be used from SNOMED CT or other code system including local codes. Refer to the section on  Extensible Bindings Rank Code (SCT ID) Preferred Term US Core Definition 0 1156699004 Complies with drug therapy (finding) The medication is being taken as directed. 0 702565001 Non-compliance of drug therapy (finding) The medication is being taken, but not as directed.( e.g., occasionaly forgets to take or 2 pills instead of 3)) 1 275928001 Drugs - partial non-compliance (finding)   1 275927006 Drugs - total non-compliance (finding)   0 457831000124109 Medication therapy compliance variable (finding)   0 715036001 Does not take medication (finding) The medication is not being taken Armed with these definitions, we can map these scenarios from the tracker: -Patient is supposed to take 30 mg twice daily and has reported they're only taking their morning dose -> 702565001 -Patient is supposed to take 30 mg twice daily and has reported they're taking 20 mg twice daily zc -> 702565001 -Patient is supposed to take 30 mg twice daily. They are following the prescribed instructions, but data from a pill tracker indicates they're regularly forgetting doses. -> 702565001 -Patient is supposed to take 30 mg twice daily. They are very compliant when they have supply, but can't always afford to refill the medication on time. -> 702565001  -Patient received adherence coaching a few months ago and is currently complying with their medications. Their PDC score for the year hasn't fully caught up and is under 50%. -> 1156699004 ? require clinical interpretation which outside the scope of US Core.
    • Brett Marquard/Eric Haas: 17-0-0
    • Enhancement
    • Compatible, substantive

    Description

      The values for medication adherence are unclear: values could refer both to the quantity of doses taken, and whether the timing and amount of those doses matches prescribed instructions. Non-compliance could refer to frequent missed doses, or could refer to a patient deviating from instructions in some other way.

      It's not fully clear which of these situations would fall into "Drugs - partial non-compliance," "Medication therapy compliance variable," or "Complies with drug therapy":

      -Patient is supposed to take 30 mg twice daily and has reported they're only taking their morning dose

      -Patient is supposed to take 30 mg twice daily and has reported they're taking 20 mg twice daily

      -Patient is supposed to take 30 mg twice daily. They are following the prescribed instructions, but data from a pill tracker indicates they're regularly forgetting doses.

      -Patient is supposed to take 30 mg twice daily. They are very compliant when they have supply, but can't always afford to refill the medication on time.

      -Patient received adherence coaching a few months ago and is currently complying with their medications. Their PDC score for the year hasn't fully caught up and is under 50%.

       
      Recommendation:
      To ensure clear communication between systems that may be using different measures of adherence, it would be helpful if guidelines were provided on how the different values are intended to be used. A field for the method used to measure adherence may also be helpful (see FHIR-43756)

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            rashid@epic.com RashidKolaghassi
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              Updated:
              Resolved: