Heroic, possibly, but futile: I missed most of the
problem in my quick stab.
I have just one more suggestion, but experience elsewhere is
that in a few problems it helps a lot. It can be awkward in Stata
to look ahead, because of the way Stata processes data, in
observation order. Therefore consider whether the problem becomes
easier if you reverse time within each panel by working, just
for this purpose, with negated dates.
Nick
[email protected]
Jeph Herrin
> Thanks Nick for a heroic effort to penetrate my overly succinct
> presentation.
>
> The idea is that when you get a script for a medication, it
> is for a certain number of days. Diabetics typically get
> drugs for 90 days, but sometimes 30 days or 14 days. If one
> drug isn't working, the doc may add a drug, or change the drug.
> If they change the drug, then we're looking at a new "index"
> drug, where going back to the first drug would then represent
> another change. If they add a drug, then the patient is taking
> two drugs. Or three drugs. They can add anytime.
>
> So each record is either 1) continue 2) switch 3) add. After
> a switch record, "continue" now refers to the new drug, not
> the original.
>
> The only way to figure out whether a new drug (not the first
> one) is a switch or an add is to "look ahead" and see if they
> get the first drug within the number of days that the first
> prescription was filled for. So if they get drug A on day 1
> for 90 days, and get drug B on day 60 for 90 days, the only
> way to know if drug B is an "add" or a "switch" is to look
> ahead to day 90 and see if there is a drug A again somewhere there.
> Maybe they are going to be taking A & B both, or maybe they
> dropped A and started B.
>
> In the patient below, the second record (drug 6) indicates an "add"
> because the first drug (drug 1) is filled again within 90 days
> (record 3). Record 3 represents a "continue" because it is the
> start drug, within the 90 days the start drug was prescribed for.
>
> +--------------------------------------------+
> | scrssn date medcat days gap |
> |--------------------------------------------|
> | 1081 16 Feb 00 1 90 . |
> | 1081 05 May 00 6 90 79 |
> | 1081 06 May 00 1 90 1 |
> | 1081 25 Jul 00 2 90 80 |
> | 1081 01 Aug 00 5 90 7 |
> | 1081 26 Sep 00 1 90 56 |
> | 1081 22 Oct 00 5 90 26 |
> | 1081 01 Nov 00 2 90 10 |
> | 1081 23 Jan 01 1 90 83 |
> | 1081 01 Feb 01 2 90 9 |
>
>
>
> My attempt so far (expanded into several lines for clarity)
> looks like:
>
>
> /* for each drug, get days til next script for same drug */
> bys scrssn medcat (date) : gen dtn=date[_n+1]-date
>
> /* could be a switch after current drug */
> gen switchable=dtn>days&dtn<.
>
> /* switch if the drug changes and previous script is switchable */
> bys scrssn (date) : gen
> switch=medcat!=medcat[_n-1]&switchable[_n-1]==1
>
> /* add if the drug changes and the previous script is not
> switchable */
> bys scrssn (date) : gen add=medcat!=medcat[_n-1]&!switchable[_n-1]==1
>
> this seems promising, but I don't see a way to fix the errors:
>
>
> +--------------------------------------------------------------------+
> | scrssn date medcat days dtn switch~e
> switch add |
>
> |--------------------------------------------------------------------|
> 1. | 1081 16 Feb 00 1 90 80 0
> 0 0 |
> 2. | 1081 05 May 00 6 90 . 0
> 0 1 |
> 3. | 1081 06 May 00 1 90 143 1
> 0 1 |
> 4. | 1081 25 Jul 00 2 90 99 1
> 1 0 |
> 5. | 1081 01 Aug 00 5 90 82 0
> 1 0 |
> 6. | 1081 26 Sep 00 1 90 119 1
> 0 1 |
> 7. | 1081 22 Oct 00 5 90 . 0
> 1 0 |
> 8. | 1081 01 Nov 00 2 90 92 1
> 0 1 |
> 9. | 1081 23 Jan 01 1 90 . 0
> 1 0 |
> 10. | 1081 01 Feb 01 2 90 . 0
> 0 1 |
>
> Ignoring obs 3 which should not be a switch or an add, we
> find that obs 4
> is a switch as desired but obs 5 which should be an add is a switch.
>
> And so on.
>
> Hope this makes more sense.
>
> Jeph
>
>
>
> Nick Cox wrote:
> > I only have understood part of this. I don't understand any of
> > the stuff about number of days at all. Perhaps there are some U.S.
> > specific details here which you are assuming understood.
> >
> > The categories, with an arbitrary code for discussion,
> > seem to include first (1) add (2) switch (3).
> >
> > Start at the "first"s.
> >
> > bysort scrssn (date) : gen byte code = 1 if _n == 1
> >
> > At this point everything else in -code- is missing.
> >
> > That leaves the "add"s, which are later but the same
> > as the first.
> >
> > by scrssn : replace code = 2 if missing(code) and code==code[1]
> >
> > Then everything else is "switch":
> >
> > replace code = 3 if missing(code)
> >
> > I hope this helps a bit.
> >
> > Nick
> > [email protected]
> >
> > Jeph Herrin
> >
> >> This has me tearing my (sparse enough) hair out, thought
> >> I'd share that experience with others...
> >>
> >> I have prescription data on patients (-id-); once they start on a
> >> diabetic medication (-medcat-), they can either stay on
> it, switch, or
> >> add a new one. For each prescription, there is the number of -days-
> >> the script is good for. Here is one patient, where I have
> >> also calculated
> >> the -gap- in days between each fill date:
> >>
> >> +--------------------------------------------+
> >> | scrssn date medcat days gap |
> >> |--------------------------------------------|
> >> | 1081 16 Feb 00 1 90 . |
> >> | 1081 05 May 00 6 90 79 |
> >> | 1081 06 May 00 1 90 1 |
> >> | 1081 25 Jul 00 2 90 80 |
> >> | 1081 01 Aug 00 5 90 7 |
> >> | 1081 26 Sep 00 1 90 56 |
> >> | 1081 22 Oct 00 5 90 26 |
> >> | 1081 01 Nov 00 2 90 10 |
> >> | 1081 23 Jan 01 1 90 83 |
> >> | 1081 01 Feb 01 2 90 9 |
> >>
> >>
> >> So this patient started on medcat=1, for 90 days, but after 79 days
> >> got a different med, medcat=2, but refilled the original medcat=1
> >> on day 80. This means that the second record indicates an "add"
> >> instead of a "switch". However, the next time they got their start
> >> med was on 26 Sep 2000, 80+7+56 = 143 days after 6 May, so the
> >> med on 25 Jul 2000 represents "switch" to medcat=2, and the med
> >> on 26 Sep 2000 represents a switch back to the original med.
> >>
> >> What I need to do is operationalize this logic, and mark every
> >> record that is not the index med (first medication) as either
> >> a switch, an add, or a continuation. I have written piles of
> >> useless code for this today, and imagine I am missing some
> >> very useful insight/adofile/nerve that would do the trick. Rather
> >> than paste in the broken bits here, I thought I'd leave it open
> >> for free-thinking listers... Any pointers?
> >>
> >> Other info:
> >> it is just chance that all of the -days- here are 90;
> many patients
> >> also have 14 & 30 day scripts)
> >> there are only 6 distinct -medcat- medication categories, so they
> >> could be handled one at a time
> >> as long as the last record is within the -days- covered
> by the last
> >> switched or continued medcat, it is considered an -add-
> >>
> >>
> >> I keep thinking the solution is of the form
> >>
> >> bys scrssn (date) : <loop over 1/_N for each record>
> >>
> >> but can't see a way to do it.
> >
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