D

Measuring & improving Adherence

Subjective Measures - The Clinical Interview

  • The patient is interviewed and asked questions to gather an understanding of their adherence to their medication.

  • The Medical Adherence Measure (MAM) is an example of a semi-structured clinical interview.

  • The interview evaluates patients' grasp of their treatment plan, adherence, use of aids like reminders, and perceived obstacles to sticking with the regimen.

  • Interviews like the MAM prioritize a supportive patient-practitioner dynamic, aiming to provide guidance and support to enhance adherence and elevate patient care.

Evaluation

  • Allows insight into the patients' thoughts and feelings about their treatment.

  • Patients may not tell the truth due to embarrassment, guilt, or fear of trouble.

Example Study: Riekert and Drotar (1999)

  • Aim: Examine implications of non-participation in studies using self-report.

  • Procedure: Investigated treatment for adolescents with diabetes (ages 11-18).

    • 80 out of 94 families approached consented to participate, completing questionnaires and interviews.

  • Results:

    • 52 families returned the follow-up questionnaire.

    • Categorized into 3 groups: Participants (52), Non-returners (28), Non-consenters (14).

  • Conclusions: Families that returned the questionnaires had adolescents with higher adherence interview scores and tested blood sugar more frequently; indicating that those participating in self-report studies are more likely adherers, thus distorting the validity of this type of study.

Objective Measures

Medical Dispensers

  • Products that allow for correct tablets to be placed in containers for each day of the week, aiding in adherence measurement.

  • At the end of the week, professionals can easily see any remaining tablets to gauge non-adherence.

Pill Counting

  • Patients bring medications for review and conduct pill counts afterward to determine adherence percentage.

Evaluation

  • Objective way of measuring non-adherence, informing medical professionals.

  • Depends on patients bringing all medications to each appointment and cannot track dosage patterns.

Example Study: Chung and Naya (2000)

  • Aim: Assess compliance with oral asthma medication (Zafirlukast).

  • Procedure: 57 asthma patients received a Track Cap that recorded medication usage over 12 weeks.

  • Results:

    • Median adherence: 71%, median compliance: 89%.

    • Compliance measured higher by tablet count (92%).

  • Conclusions: Compliance remained high throughout treatment, indicating that the TrackCap effectively measures adherence.

Biological Measures of Non-Adherence

  • Blood and urine samples provide the most accurate measure of adherence by indicating drug levels in the system.

Evaluation

  • Objective, valid, and reliable measure not reliant on patient honesty.

  • Expensive, time-consuming, and considered invasive.

Improving Adherence Techniques

  • Individual techniques (personalized prompts, contracts, tailored treatment) or community interventions (lotteries, reminders) can enhance adherence.

  • Contracts can improve adherence short-term (Bosch-Capblanch et al., 2007). Text reminders have shown mixed results (Strandbygaard et al., 2010).

Ley (1988) Review on Patient Satisfaction

  • Found 28% of UK patients reported low satisfaction with treatment, higher in hospitals at 41%.

  • Patients are ‘information seekers’ wanting to know more about their disorder, impacting adherence.

Example Study: Chaney et al. (2004)

  • Aim: Improve adherence in children with asthma using Funhaler.

    • Compared with a traditional spacer.

  • Procedure: 32 children used Funhaler and provided treatment frequency data.

  • Results:

    • 59% used regular inhaler vs. 81% Funhaler.

    • Increased adherence and fewer issues with the Funhaler.

  • Conclusion: Funhaler improved adherence and made treatment more enjoyable.