Stream: implementers
Topic: MedicationUsage adherence and not-taking
Arianne van de Wetering (Sep 09 2021 at 10:05):
I have a question about a newly introduced field in the build version of MedicationUsage: adherence. Looking at the valueSet, this concept seems to actually combine two concepts: whether or not the patient is taking the medication and whether this was done as instructed.
Why the combination of two concepts in one field? The descriptive definition of the .adherence field only refers to instruction.
The patient may also have been instructed to NOT take the medication. Is that a use case that has been considered? It does not seem so looking at the example valueSet ?
The current example valueSet seems to have an ambiguous description for the code "taking-not-as-directed". The current description is: "The medication is not being taken as directed" which may be interpreted as 'not taken'. But seems how this value is hierarchically under 'taking' I believe a better description is: "The medication is being taken, but not as instructed."
Side question: why does the description of the field use the word 'instructed' and the valueset the word 'directed'? Is that deliberate, or a simple inconsistency?
Lloyd McKenzie (Sep 09 2021 at 15:09):
@Melva Peters
Jose Costa Teixeira (Sep 20 2021 at 13:21):
Arianne van de Wetering said:
Side question: why does the description of the field use the word 'instructed' and the valueset the word 'directed'? Is that deliberate, or a simple inconsistency?
I think this should be clear
Jose Costa Teixeira (Sep 20 2021 at 13:23):
Arianne van de Wetering said:
The current example valueSet seems to have an ambiguous description for the code "taking-not-as-directed". The current description is: "The medication is not being taken as directed" which may be interpreted as 'not taken'. But seems how this value is hierarchically under 'taking' I believe a better description is: "The medication is being taken, but not as instructed."
I also think this should be changed to remove ambiguity.
Melva Peters (Sep 20 2021 at 13:33):
@Jean Duteau
Jose Costa Teixeira (Sep 20 2021 at 13:38):
Arianne van de Wetering said:
I have a question about a newly introduced field in the build version of MedicationUsage: adherence. Looking at the valueSet, this concept seems to actually combine two concepts: whether or not the patient is taking the medication and whether this was done as instructed.
Why the combination of two concepts in one field? The descriptive definition of the .adherence field only refers to instruction.
The patient may also have been instructed to NOT take the medication. Is that a use case that has been considered? It does not seem so looking at the example valueSet ?
I think that these 2 concepts (taking or not; as instructed or deviating from instructions) are not perfectly orthogonal (e.g. if you are instructed to take but you don't take it at all, you are both not taking and you are not adhering to the treatment. OTOH you are also not adhering if the instruction is "during this week, do not take" and you still take it.
In any case, this should be clarified. Perhaps this notion of "adherence" field is supposed to be a summarizing field?
In any case, I suggest that at least the different combinations of "taking/not taking" and "as instructed / not as instructed.. " should be listed and an adherence flag indicated for those - and if this flag is not unambiguous, this element would need to be split then.
Arianne van de Wetering (Sep 20 2021 at 15:52):
@Jose Costa Teixeira : Thanks for your comments. I agree that whether you are taking medication and whether this is "as instructed" are two separate concepts. Which is why, in our Dutch national functional models for medication use, we have indeed separated the two concepts into 'asAgreedIndicator' en 'useIndicator'.
Last updated: Apr 12 2022 at 19:14 UTC
