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Comparing adherence estimates resulting from CMG and NPMG methods reveals the differences that result from their distinct inclusion criteria and assumptions (Table 3).
In the validation study, we detected a significant (p = .0012), discriminating relationship between the distribution of NPMG's classification of adequate (<20 percent gap) versus poor adherence ([greater than or equal to] 20 percent gap in medication) and self-reported adherence (0, 1, or [greater than or equal to] 2 days missed in past week) for cholesterol-lowering medications (Figure 2).
In our cohort, 28.9 percent (95 percent CI [+ or -] 0.55 percent; 5,422/18,770) were classified as having inadequate adherence ([greater than or equal to] 20 percent gap in medication) based on CMG, a conventional measure of secondary adherence, while 47.4 percent (95 percent CI [+ or -] 0.59 percent; 12,954/27,329) received that classification based on NPMG. Thus, our findings suggest that the current public health burden associated with inadequate medication adherence may be larger than previously thought.
The validation study suggests that, among ongoing users, NPMG performed similarly to a well-accepted, objective secondary adherence measure (CMG) in predicting response to newly initiated statin therapy.
Finally, because both CMG and NPMG integrate adherence over an extended observation window for their respective populations (ongoing users and all patients prescribed a new medication, respectively), they are imperfect predictors of clinical effectiveness.
NPMG provides a valid, comprehensive measure of adherence, which can be used in addition to existing metrics currently available to study medication adherence.
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