Adjusted trajectory of medication exposure taking into account the periodicity of dispensations and the number of dispensed packs and comparative analysis on EFEMERIS database

Abstract

We presented an adjustment method for the calculation of medication exposure trajectories based on the number of dispensed packs and the type of dispensations (occasional or regular). A comparative study based on the EFEMERIS data was carried out using three different scenarios of trajectory calculation depending on whether or not the number of packs and the periodicity of medication dispensations were taken into account. The impact of the scenario was highlighted using global indicators on the number of Define-Daily Dose (DDD) on all women exposed; the study of changes in individual trajectories from one scenario to another was carried out; we also compared the results of a clustering into four groups. If 65% of the trajectories remained unchanged, we could observe on the rest significant changes in number of DDD and/or on individual exposure profile. We observed 4% of trajectories that were attributed to a different cluster, and the clustering was of better quality with the adjustment method. Depending on the study context, an impact on cluster distribution could be observed for some maternal characteristics and neonatal outcomes. This was the case for a higher occurrence of neonatal pathology for neonates from mothers belonging to the cluster with high doses of psychotropics, thus reinforcing the conclusions of previous studies of a link between high exposure to psychotropic medications and presence of pathology for the newborn.