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Am J Manag Care. 2015 Nov 1;21(11):e601-8.

Using sequence discovery to target outreach for diabetes medication adherence.

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500 W Main St, Louisville, KY 40202. E-mail:



To investigate exposure sequences correlated with gaps in diabetes medication refills and to identify opportunities for targeted outreach for improved adherence.


Sequence discovery was used to identify exposures from various data sources that preceded a gap in diabetes medication refills.


Patients who refilled a diabetes medication and had 6 months of continuous refill history were included. Patients with a therapy gap between February 1, 2012, and March 31, 2013, formed the gap group; those without formed the no-gap group. Gaps were defined as a prescription refill obtained 6 days or more after the days' supply of the previous refill. Exposure sequences were explored in the 90 days before the gap, or before the date of last refill in the study period for the no-gap group. Exposures and sequences offering opportunity for health plan outreach were identified based on sequence length, confidence, number of intervention points, and higher gap group prevalence.


Three exposure sequences with the greatest outreach opportunity to impact downstream adherence were identified within individuals taking diabetes medications who: 1) are prescribed a new medication-especially those with multiple out-of-network claims and/or visit a specialty physician after the new medication is prescribed; 2) have a prescription claim reversed by a pharmacist-particularly patients who are subsequently prescribed a new medication or visit a specialty physician; and 3) have multiple out-of-network claims and a hospitalization.


As medication adherence is a persisting challenge, novel application of sequence discovery techniques identified unique sequences of events with opportunities for outreach.

[Indexed for MEDLINE]
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