Friday, 15 May 2015
PROBING NON-ADHERENCE TO PRESCRIBED MEDICINES? A BIVARIATE DISTRIBUTION WITH INFORMATION NUCLEUS CLARIFIES
To start with, the case of too many prescribed medicines is
examined. Then, the repeated hospitalization due to non-adherence is examined.
The contents of this article could be easily extended to other reasons of
non-adherence as well. In the presence of a reason, there might exist a number
of non-adherent X and a number of adherent, Y patients. Both X and Y is
observable in a sample of size n1 with the presence of a reason and in another
random sample of size n2 with the absence of a reason. The total sample size is
n = n1 + n2. Let 0<Φ<1 and 0<Ï<1 denote respectively the
probability for a reason to exist in a patient and the probability for a
patient to be non-adherent to the prescribed medicines. Of interest to the
medical community is the trend of the sum, T = X+Y and Z = n-X-Y denoting
respectively the total number of non-adherent and adherent patients
irrespective of a reason. Hence, this article constructs a bivariate
probability distribution for T and Z utilize it to explain several
non-trivialities. To illustrate, non-adherence patientsâ data in the
literature are considered. Because the bivariate probability distribution is
not seen in the literature, it is named as non-adherent bivariate distribution.
Various statistical properties of the non-adherent bivariate distribution are
identified and explained. An information based hypothesis testing procedure is
devised to check whether an estimate of the parameter, Ï is significant. Two
closely connected factors for the patients not adhering to the prescribed
medicines are examined. The first is a precursor and it is that too many
medicines are prescribed to take. In an illustration for the first reason, the
probability for a patient not to adhere the medicines is estimated to be 0.78
which is statistically significant. The second is the post cursor and it is
that the patients not-adhering to the medicines are more often hospitalized
again. In an illustration of the second factor, the probability for the
diabetic patients not to adhere the medicines is estimated to be 0.44 which is
significant. The statistical power of accepting the true non-adherence
probability by our methodology is excellent in both illustrations. A few
comments are made about the future research work. Other reasons for the
patientsâ non-adherence might exist and they should also be examined. A
regression type prediction model can be constructed if additional data on
covariates are available. A principal component analysis might reveal clusters
of reasons along with the grouping of illnesses if such multivariate data
become available. The usual principal component analysis requires bivariate
normally distributed data. For the data governed by the non-adherent bivariate
distribution, a new principal component methodology needs to be devised and it
will be done in a future research article. The contents of this article is the
conceptual foundation for such future research work.
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