Sr Data Scientist OMNY Health Atlanta, United States
Background: Reasons for treatment alteration, including permanent discontinuation, dosage/frequency modification, and temporary discontinuation of pharmacologic therapies, are typically only available in electronic health record (EHR) unstructured data and consequently poorly understood at a large scale. Knowledge of reasons for treatment alteration could help inform pharmacoepidemiology studies and present opportunities to improve upon current treatment regimens.
Objectives: To develop and validate categories of reasons for treatment alteration in the real-world setting using unstructured clinical notes of dermatology patients.
Methods: Unstructured clinical notes from 2017-2021 available in patient EHRs from 5 specialty dermatology networks in the OMNY Health Database were accessed and deidentified. Sentences or paragraphs that were tagged as relevant to treatment modification by the EHR were included. Approximately 0.3% of these sentences were randomly sampled, manually reviewed, and grouped into 9 categories of treatment alteration reasons: adverse drug event (ADE), symptom resolution (RES), drug ineffectiveness (IEF), financial or insurance coverage reasons (FIN), inconvenience of treatment instructions / possible misuse (MIS), pregnancy (PRG), medication abuse (ABU), interaction with another drug (INT), and other (OTH). Percentage of reasons belonging to each category were calculated.
Results: Approximately 448M note entries (sentences or paragraphs) across 4.1M patients and 16.0M encounters were accessed. Of these entries, 569,155 (0.1%) were tagged by the EHR as relevant to treatment alteration. Of the 1,745 entries manually reviewed, 1,650 (94.6%) contained only a drug name without a reason for modification, and 95 (5.4%) contained at least one reason, with one entry containing two reasons. Counts and percentages of the reasons observed were as follows: ADE: 50 (52.0%), RES: 13 (13.5%), IEF: 16 (16.7%), FIN: 6 (6.3%), MIS: 0 (0.0%), PRG: 4 (4.2%), ABU: 0 (0.0%), INT: 3 (3.1%), and OTH: 4 (4.2%).
Conclusions: Reasons for treatment alteration are not commonly documented in the designated EHR section in the real-world dermatology setting. Over half of treatment regimens were altered due to an ADE, and IEF and RES were the second and third most observed reasons, respectively. Other reasons observed were FIN, PRG, and INT, while ABU and MIS were not observed. Only 4% were categorized as OTH, indicating that the other 8 categories adequately cover the spectrum of treatment alteration reasons. Directions for future research may include the implementation of natural language processing models to automatically classify reasons for treatment alteration in unstructured clinical notes.
