A Scoping Review of Methods Used to Assess Medication Adherence in Patients with Chronic Conditions

2021 ◽  
Author(s):  
Pinelopi Konstantinou ◽  
Orestis Kasinopoulos ◽  
Christiana Karashiali ◽  
Geοrgios Georgiou ◽  
Andreas Panayides ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Quality Indicators ◽  
Scoping Review ◽  
Chronic Conditions ◽  
Electronic Monitoring ◽  
Intervention Development ◽  
Assessment Methods ◽  
Self Report ◽  
Evidence Based ◽  
Gold Standard Method

Abstract Background Medication nonadherence of patients with chronic conditions is a complex phenomenon contributing to increased economic burden and decreased quality of life. Intervention development relies on accurately assessing adherence but no “gold standard” method currently exists. Purpose The present scoping review aimed to: (a) review and describe current methods of assessing medication adherence (MA) in patients with chronic conditions with the highest nonadherence rates (asthma, cancer, diabetes, epilepsy, HIV/AIDS, hypertension), (b) outline and compare the evidence on the quality indicators between assessment methods (e.g., sensitivity), and (c) provide evidence-based recommendations. Methods PubMed, PsycINFO and Scopus databases were screened, resulting in 62,592 studies of which 71 met criteria and were included. Results Twenty-seven self-report and 10 nonself-report measures were identified. The Medication Adherence Report Scale (MARS-5) was found to be the most accurate self-report, whereas electronic monitoring devices such as Medication Event Monitoring System (MEMS) corresponded to the most accurate nonself-report. Higher MA rates were reported when assessed using self-reports compared to nonself-reports, except from pill counts. Conclusions Professionals are advised to use a combination of self-report (like MARS-5) and nonself-report measures (like MEMS) as these were found to be the most accurate and reliable measures. This is the first review examining self and nonself-report methods for MA, across chronic conditions with the highest nonadherence rates and provides evidence-based recommendations. It highlights that MA assessment methods are understudied in certain conditions, like epilepsy. Before selecting a MA measure, professionals are advised to inspect its quality indicators. Feasibility of measures should be explored in future studies as there is presently a lack of evidence.

scholarly journals Barriers, facilitators, and interventions for medication adherence across chronic conditions with the highest non-adherence rates: a scoping review with recommendations for intervention development

2020 ◽  
Author(s):  
Pinelopi Konstantinou ◽  
Angelos P Kassianos ◽  
Giοrgos Georgiou ◽  
Andreas Panayides ◽  
Alexia Papageorgiou ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Behavioral Health ◽  
Scoping Review ◽  
Low Income ◽  
Chronic Conditions ◽  
Health Interventions ◽  
Barriers And Facilitators ◽  
World Health ◽  
Medication Cost ◽  
Multicomponent Interventions

Abstract Medication non-adherence (MNA) constitutes a complex health problem contributing to increased economic burden and poor health outcomes. The Medication Adherence Model (MAM) supports that numerous processes are involved in medication adherence (MA). Based on the MAM and guidelines of the World Health Organization (WHO), this scoping review aimed to identify the barriers and facilitators associated with MA, and the behavioral health interventions and techniques among chronic conditions presenting with high non-adherence rates (asthma, cancer, diabetes, epilepsy, HIV/AIDS, and hypertension). PubMed, PsycINFO, and Scopus databases were screened, and 243 studies were included. A mixed methods approach was used to collate the evidence and interpret findings. The most commonly reported barriers to MA across conditions were younger age, low education, low income, high medication cost, side effects, patient beliefs/perceptions, comorbidities, and poor patient–provider communication. Additionally, digitally delivered interventions including components such as medication and condition education, motivational interviewing (MI), and reinforcement and motivational messages led to improvements in MA. This review highlights the importance of administrating multicomponent interventions digitally and personalized to the patients’ individual needs and characteristics, responding to the adherence barriers faced. This is the first review examining and synthesizing evidence on barriers and facilitators to MA and behavioral health interventions used for improving MA across chronic conditions with the highest non-adherence rates and providing recommendations to researchers and clinicians. Stakeholders are called to explore methods overcoming barriers identified and developing effective multicomponent interventions that can reduce the high rates of MNA.

Quantifying Glaucoma Medication Adherence: The Relationship Between Self-Report, Electronic Monitoring, and Pharmacy Refill

2016 ◽  
Vol 32 (6) ◽  
pp. 346-354 ◽  
Author(s):  
Jaya B. Kumar ◽  
Hayden B. Bosworth ◽  
Betsy Sleath ◽  
Sandra Woolson ◽  
Maren Olsen ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Electronic Monitoring ◽  
Self Report ◽  
Glaucoma Medication ◽  
Pharmacy Refill ◽  
The Relationship

Abstract P180: Time to Screen for Medication Non-Adherence in Patients with Uncontrolled Hypertension? Comparing the Test Properties of Two Commonly Used Self-Report Adherence Questionnaires

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Ian M Kronish ◽  
Benjamin Gallagher ◽  
Siqin Ye ◽  
Donald Edmondson
Keyword(s):  
Medication Adherence ◽  
Gold Standard ◽  
Electronic Monitoring ◽  
Negative Likelihood Ratio ◽  
Self Report ◽  
Uncontrolled Hypertension ◽  
Care Practice ◽  
Sensitivity Specificity ◽  
Perfect Adherence ◽  
Poor Medication Adherence

Introduction: One major cause of uncontrolled hypertension is poor medication adherence. Yet, clinicians are poor at judging adherence and the gold standard for measuring medication adherence - electronic monitoring - is rarely available in clinic settings. Self-report adherence questionnaires, by contrast, are free, simple to administer, and may be useful for screening. Hypothesis: To compare the test properties of the Morisky Medication Adherence Questionnaire (MMAQ) and the Visual Analog Scale (VAS) for diagnosing non-adherence in patients with uncontrolled hypertension, using electronic pillbox monitoring as the gold standard. Methods: Thus far, 48 patients with uncontrolled hypertension [BP ≥140/90 mmHg (or ≥130/80 mmHg if diabetic) on 2 serial clinic visits] have been enrolled during visits to a hospital-based primary care practice. Patients are asked to take up to 4 of their BP medications from a 4-bin electronic pillbox (MedSignals) that records the date and time each bin is opened. At the next visit, patients complete the MMAQ, comprised of 8 brief questions that assess pill-taking behavior. The MMAQ is scored from 0 to 8; 8 signifies perfect adherence. Patients also complete the VAS by marking an “X” on a line from 0% to 100% to indicate how often they took each of their BP medications. Sensitivity, specificity, and negative likelihood ratio (NLR) were assessed for each test. The gold standard for adherence was ≥ 80% adherence averaged across each of the electronically monitored medications. Results: Mean age is 62 years (range 34 [[Unable to Display Character: –]] 83), 70% women, 62% Hispanic, 52% Black, and 50% with diabetes. Mean BP at enrollment was 160/88 mmHg. Patients were prescribed a mean (SD) of 2.6 (0.9) BP medications. Adherence was monitored for 41 +/- 23 days. Mean adherence by electronic monitoring was 78% (range 13%-100%); 42% were adherent (≥ 80%) by the gold standard. Using a cutpoint of 7.5 (67% of the sample were below this cutpoint), the MMAQ has a sensitivity of 94% and specificity of 54%, corresponding to a NLR of 0.10 (95%CI 0.01 to 0.67). Using a cutpoint of 80% (only 11% of the sample below this cutpoint), the VAS has a sensitivity of 28%, specificity of 67%, and a NLR of 0.72. Conclusions: The MMAQ, but not the VAS, is a sensitive tool for screening for non-adherence in patients with uncontrolled hypertension and may be useful for excluding medication non-adherence as the cause of uncontrolled hypertension for a large proportion of patients.

scholarly journals Building a Global, Pediatric Vascular Access Registry: A Scoping Review of Trial Outcomes and Quality Indicators to Inform Evidence‐Based Practice

2019 ◽  
Vol 16 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Jessica A. Schults ◽  
Claire M. Rickard ◽  
Tricia Kleidon ◽  
Rebecca Hughes ◽  
Fiona Macfarlane ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Vascular Access ◽  
Scoping Review ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Trial Outcomes

scholarly journals Impact of Once- Versus Twice-Daily Tacrolimus Dosing on Medication Adherence in Stable Renal Transplant Recipients: A Canadian Single-Center Randomized Controlled Trial

2019 ◽  
Vol 6 ◽  
pp. 205435811986799 ◽  
Author(s):  
Theone S. E. Paterson ◽  
Maryam Demian ◽  
Rebecca Jean Shapiro ◽  
Wendy Loken Thornton
Keyword(s):  
Medication Adherence ◽  
Renal Transplant ◽  
Electronic Monitoring ◽  
Self Report ◽  
Categorical Variables ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Multiple Methods ◽  
Once Daily ◽  
Randomized Controlled

Background: Prevalence of immunosuppressant nonadherence in renal transplant recipients is high despite negative clinical outcomes associated with nonadherence. Simplification of dosing has been demonstrated to improve adherence in renal transplant recipients as measured through electronic monitoring and self-report. Objective: The purpose of this study was to replicate and extend previous findings by measuring adherence with multiple methods in a Canadian sample. Design: The study design was a randomized controlled medication dosing trial in adult renal transplant patients. The trial length was 4 months. Setting: This study was conducted within the Solid Organ Transplant (SOT) Clinic at Vancouver General Hospital (VGH; Vancouver, Canada). Patients: A total of 46 adult renal recipients (at least 1 year post-transplant) were recruited through the SOT clinic. With 8 withdrawals, 38 individuals completed all phases of the study. Measurements: Medication adherence was measured for a period of 4 months using multiple methods, including electronic monitoring (MEMS [Medication Event Monitoring System]), pharmacy refill data (medication possession ratio [MPR]), and by self-report using the Adherence subscale of the Transplant Effects Questionnaire (TEQ). Methods: Participants were randomized to twice-daily (n = 19) or once-daily tacrolimus dosing (n = 19) and followed over a 4-month period via monthly clinic study visits. Comparisons between the treatment groups were performed using the Mann-Whitney U and chi-square tests, for continuous and categorical variables, respectively. Results: As outlined in Table 3, the once-daily dosing group showed significantly better MEMS Dose Adherence ( P = .001), whereas MEMS Timing Adherence showed a tendency toward better adherence for this group, but was not significant ( P = .052). MEMS Days Adherent ( P = .418), MPR% ( P = .123), and self-reported adherence ( P = .284) did not differ between the once- and twice-daily dosing groups when measured as continuous variables. The MPR% was significantly better for the once-daily dosing group when measured dichotomously but not continuously ( P = .044). Notably, most of those exposed to once-daily dosing (63.2%) preferred this to the twice-daily regimen. Limitations: Limitations included small sample size and short follow-up period, precluding the examination of clinical outcome differences. Conclusions: Results for dose adherence replicate the finding that dose simplification increases adherence to immunosuppressants as measured through electronic monitoring. Such an advantage for the once-daily dosing group was not seen across the 2 other electronic monitoring measurement variables (days and timing adherence). This study extends previous research by examining adherence in once versus twice-daily dosing via prescription refill data in a Canadian sample. Given the gravity of potential health outcomes associated with nonadherence, although results indicate inconsistencies in significance testing across measurement methods, the medium to large effect sizes seen in the data favoring better adherence with once-daily dosing provide an indication of the potential clinical significance of these findings. Trial registration: This study was registered with ClinicalTrials.gov (NCT01334333) on April 11, 2011.

scholarly journals Medication Adherence: A Review and Lessons for Developing Countries

2019 ◽  
Vol 15 (11) ◽  
pp. 104
Author(s):  
Adebayo Omotosho ◽  
Peace Ayegba
Keyword(s):  
Developing Countries ◽  
Medication Adherence ◽  
Adverse Effects ◽  
Chronic Conditions ◽  
Evidence Based ◽  
Treatment Modification ◽  
Evidence Based Treatment ◽  
Need For Treatment ◽  
Passive Compliance

Most of the time, complete adherence to prescribed medication is a big step towards recovery from either chronic or acute diseases, but patients often are unaware of the adverse effects that could arise from inconsistency in adherence. The inability of patients to adhere to prescription can affect the potency of some effective therapies known to treat many conditions, and passive compliance may result in the development of resistant to drug causing a need for treatment modification. Shockingly, more than half of the drugs prescribed for patients with chronic conditions like diabetes and hypertension were found not to be taken as recommended.  Adherence is so important because it can assist clinicians in successful supervision of evidence-based treatment of patients; therefore this paper presents an overview of medication adherence, non-technology and technology-based approaches, and lessons for developing countries.

Application of the Non-adoption, Abandonment, Scale-up, Spread and, Sustainability (NASSS) Framework to evaluate the role of technology in the Pathways to Comorbidity Care (PCC) implementation project to improve management of comorbid substance use and mental disorders

2020 ◽  
Author(s):  
MariaGabriela Uribe Guajardo ◽  
Andrew James Baillie ◽  
Eva Louie ◽  
Vicki Giannopoulos ◽  
Katie Wood ◽  
...  
Keyword(s):  
Substance Use ◽  
Clinical Supervision ◽  
Mental Health Problems ◽  
Scale Up ◽  
Structured Interview ◽  
Barriers And Facilitators ◽  
Self Report ◽  
Evidence Based ◽  
Face To Face ◽  
Drug And Alcohol

Abstract (250 words)In substance use treatment settings, there is a high prevalence of comorbid mental health problems. Yet an integrated approach for managing comorbidity, implementation of evidence-based intervention in drug and alcohol settings remains problematic. Technology can help the adoption of evidence-based practice and successfully implement effective treatment health care pathways. This study sought to examine aspects of electronic resources utilisation (barriers and facilitators) by clinicians participating in the PCC training. MethodA self-report questionnaire and a semi-structured interview was designed to measure overall satisfaction with the PCC portal and e-resources available throughout the 9-month intervention for participating clinicians. An adapted version of the ‘Non-adoption, Abandonment, Scale-up, Spread and, Sustainability’ (NASSS) framework was used to facilitate discussion in regards to the study findings. ResultsA total of 20 clinicians from drug and alcohol services responded to all the measures. Facilitators of portal use included: i. clinician acceptance of the PCC portal; ii. guidance from the clinical supervisor or clinical champion that encouraged the use of e-resources. Some of the barriers included: i. complexity of the illness (condition), ii. clinicians’ preference (adopter system) for face-to-face resources and training modes (e.g. clinical supervision, clinical champion workshops), and iii. lack of face-to-face training on how to use the portal (technology and organisation).ConclusionBased on the NASSS framework, we were able to identify several barriers and facilitators including such as the complexity of the illness, lack of face-to-face training and clinician preference for training mediums. Recommendations include ongoing consultation of clinicians to assist in the development of tailored e-health resources and offering in-house training on how to operate and effectively utilise these resources.

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