Visualisation of patient histories using multiple data sources. Presented by Dr Eric van Ganse on behalf of the ASTROLAB Group

1. LONGITUDINAL ASTHMA MANAGEMENT PROFILES:
VISUALISATION OF PATIENT HISTORIES USING
MULTIPLE DATA SOURCES
REG Annual Summit
Lyon
15 &16 April 2016
Eric van Ganse
on behalf of the
ASTROLAB group
ASTROLAB consortium: Consorcio Mar Parc de Salut de Barcelona, IMS Health, Kappa Santé SAS, Lyon
Ingénierie Projets, University Claude Bernard Lyon 1, University of Amsterdam, University of Nottingham

2. Background
Computerized Health Data
CHD
Valuable information for research and
clinical case management with real-life
data, but currently underused.
CHD limitations:
- Limited information on medication use
from single data source
- Health outcomes from single data
source
- No obvious way to build patient full
medical histories.
ASTROLAB Design: Linkage of multiple data sources:
1. Direct patient follow-up (PROs)
2. EHRs from GPs
3. French national claims data

3. Objective
To develop longitudinal asthma management
patient profiles for the ASTROLAB cohort by
integrating data on prescription and
dispensation events, and patient-reported
information on medication use and occurrence
of severe asthma exacerbations (SAEx).
Better understanding of asthma management.
To check the asthma care model developed by
ASTROLAB

4. Methods: patients
• 1,051 children and adults with persistent asthma (6 to 40 years old)
• From France and the United Kingdom (UK)
• On a stable therapy pattern (for ≥6 of 12 baseline months) of either:
– Long acting β-agonists (LABAs) without inhaled corticosteroids (ICs)
– ICs without LABAs
– LABAs + ICs in separate canisters
– LABAs/ICs fixed-dose combination (FDC)

5. Methods: cohort design
Main outcome: Severe Asthma Exacerbation (SAEx)
 Occurrence of asthma-related courses of oral corticosteroids
 Unscheduled medical visits
 Unscheduled hospital contacts (ER visits, overnight hospitalizations)
 Death due to asthma

6. PATIENTS
- Phone interviews
- Text messages
- Online
Questionnaires
HEALTHCARE
PROFESSIONALS
- Online
Questionnaires
- Electronic Medical
Records
Methods: multiple data sources
FRENCH CLAIMS
DATA
- Refills
- Medical resource
utilization (MRU)
Probabilistic linkage
with French Claims Data

7. CATI M4
Non-use in
the past 7
days
How to interpret longitudinal asthma
management profiles?
Prescription with duration
Corresponding
dispensation (D)
on the same day
M0
CATI M8
Use in the
past 7 days
CATI M12
Use in the
past 7 days
D
D
D
D
D
D
D
D
CATI M16
Non-use in the
past 7 days
CATI
M20
CATI
M24
Exacerbation
Exacerbation
Exacerbation
Prescription with
duration
Prescription
with duration
D
D

8. Examples of application
1. Between countries comparison of prescribing
patterns, or dispensation patterns, or
patterns of use (patients) in persistent
asthma
2. Identification of therapy switch
3. Therapeutic context of asthma exacerbation

9. 1. Comparison of asthma prescribing patterns
between countries
Example 1: difference in prescribing patterns between France and the UK

10. 2. Identification of switch of therapy (2/3)
Example 2: illustration of
treatment switch
CATI M4
CATI M0
CATI M8
Use in the past 7 days
Switch to fixed-
dose combination
CATI M12
CATI M16
Regular prescribing and
dispensations, drug used
before CATI

11. 3. Therapeutic context of asthma exacerbation
Example 3: illustration of
prescribing, dispensing and
actual use reported by patients
and occurrence of outcome CATI M4
CATI M0
CATI M8
CATI M12
(misisng)
CATI M16
No dispensation
Actual use of therapy before
and during exacerbation
period? (no dispensations)
No dispensation

12. Conclusions
Longitudinal asthma management profiles: visualisation enables
an improved understanding of:
• Irregular exposure to controllers: distinction between
– non-prescription
– unfilled prescribed therapy
– non-use of dispensed drug
• Therapeutic context of asthma exacerbation:
– Non-exposure to controllers before an exacerbation?
– Consequences of exacerbation on subsequent therapy pattern:
reinforcement? switch?
• Generation of hypotheses to document issues in asthma
management
CHD valorisation

13. THANK YOU
Project funded by the European Commission
through the Seventh Framework Programme under GA n° 282593
Contact: Dr Eric van Ganse
eric.van-ganse@univ-lyon1.fr
http://www.astrolab-project.eu