Agreement of administrative pharmacy dispensing with self-reported use of oral prednisone in US Veterans with rheumatoid arthritis.

Abstract

Objective: Administrative claims are used to evaluate oral glucocorticoid use in rheumatoid arthritis (RA), despite limited evidence to support accuracy. We aimed to evaluate the performance of claims-based algorithms for glucocorticoid use compared to self-report in an RA population.

Methods: Participants with RA enrolled at 7 VA Rheumatoid Arthritis (VARA) registry sites were asked six questions as part of clinical care assessing current prednisone use and dose, recent use, "stockpiling", and receiving prednisone outside VA. Algorithms using VA prescription claims operationalized current use (active prescription on date of self-report assessment), current dose (that prescription's mean dose), and recent use (active course overlapping the prior 30 or 90 days). We assessed performance characteristics and agreement, benchmarked on self-report.

Results: Of 284 participants, 13% reported current prednisone use and 20% reported 90-day use. Sensitivity, specificity, PPV and NPV were 0.70, 0.98, 0.84, and 0.96 for current use, and 0.71, 0.92, 0.72, and 0.92 for 90-day use. Cohen's kappa was 0.68 for current use and 0.63 for 90-day use. Among participants reporting ≤5mg/day, agreement for dose was high (weighted kappa 0.67). One in 4 participants reported a stockpile, and 1 in 4 reported receiving prednisone from a non-VA provider.

Conclusions: Algorithms derived from VA claims detecting prednisone prescriptions have high validity compared to patient self-report. The modest sensitivity of these algorithms may reflect stockpiling and non-VA prescriptions. These findings form a basis for contextualizing real-world studies of glucocorticoid use in RA and improve clinical estimation of glucocorticoid use not captured in claims.