3.2.2 Measuring non-adherence

Question 1

Measuring non-adherence

How can we measure adherence?

Answer 1

1. Self report - asking people (questionnaires?).
2. Therapeutic outcome - have they got better?
3. Health worker estimates - ask the doctor.
4. Pill/bottle counts - raid the cupboard and see what’s left.
5. Mechanical methods - how much medicine has been dispensed?
6. Biochemical tests - blood and urine.

Question 2

Measuring non-adherence - background

Ley (1997) argued that asking doctors is one of the least affective ways to measure adherence because…?

Answer 2

Doctors vastly overestimate the extent to which their patients adhere.

Question 3

Riekart and Droter (1999)

Aim

Answer 3

To assess the implication of non/incomplete participation of adolescents with diabetes in treatment adherence research.

Question 4

Riekart and Droter (1999)

Participants

Answer 4

80 out of 92 original families (parents + adolescents aged 11-18) consented to take part in the study.

However, only 52 completed all the research.

Question 5

Riekart and Droter (1999)

What did all the adolescents suffer from?

Answer 5

Diabetes for over a year.

Question 6

Riekart and Droter (1999)

How were participants recruited?

Answer 6

Through a clinic.

Question 7

Riekart and Droter (1999)

What did the adolescents and parents complete?

Answer 7

A series of questionnaires/interviews.

Question 8

Riekart and Droter (1999)

How many of the families returned the ‘follow up’ questionnaires?

How did they submit it?

Answer 8

52 out of 80 families, they filled it in at home and posted it back?

Question 9

Riekart and Droter (1999)

What groups were families categorised into?

Answer 9

• Participants = 52
• Non-returners = 28
• Non-consenters = 14

Question 10

Riekart and Droter (1999)

Results

Answer 10

Families that returned their questionnaires had adolescents who had higher adherence interview scores and tested their blood sugar more frequently than families who did not return their questionnaires.

Question 11

Riekart and Droter (1999)

Conclusions

Answer 11

This demonstrates that those who take part in such self-report studies are more likely to be adherers and so distort this type of study.

Question 12

Chung and Naya (2000)

Aim

Answer 12

To see if patients took their medication regularly and at the correct time of day.

Question 13

Chung and Naya (2000)

Track Cap

Answer 13

An electronic device on the bottle top that recorded the date and time of the use of the medication.

Question 14

Chung and Naya (2000)

Participants

Answer 14

57 patients with asthma.

However, 10 dropped out, leaving 47 patients that took part fully.

Question 15

Chung and Naya (2000)

What were participants told about the study?

Answer 15

That adherence rates were being measured, but not about the Track Cap device and what it did.

Question 16

Chung and Naya (2000)

How often were patients to take treatment?

For how long?

Answer 16

Twice per day, 12 hours apart.

This study was carried out over a 12-week period.

Question 17

Chung and Naya (2000)

How was compliance measured?

Answer 17

• No. of times the Track Cap was opened.
• No. of days that the Track Cap was opened at 12-hour apart intervals.
• No. of pills left at the end of the 12-week period.

Question 18

Chung and Naya (2000)

Results

Answer 18

There was 80% compliance with the Track Cap, 89% with the tablet count.

(Difference due to patients taking out more than one tablet at a time to put in dispensers).

Question 19

Chung and Naya (2000)

Conclusion

Answer 19

Monitoring systems like Track Cap measured adherence effectively.

Question 20

Roth (1978) - biochemical tests

Roth claimed the only reliable/scientific way to measure medication adherence is…?

Answer 20

Biochemical tests to see if the medication is inside the person concerned.

Question 21

Roth (1978) - biochemical tests

Issues with measuring adherence via biochemical tests.

Answer 21

• They only show if they drug has been taken, not how much or when.
• It’s invasive!
• It can’t be used to measure adherence to other treatment forms. such as changes in exercise, diet or physiotherapy.

Question 22

Sherman et al. (2000)

Aim

Answer 22

To see if failure to present a prescription at a pharmacy could measure non-adherence.

Question 23

Sherman et al. (2000)

Sample

Answer 23

116 children with asthma who were interviewed with their parents/carers on visiting a clinic.

Question 24

Sherman et al. (2000)

How was patient adherence operationalised?

Answer 24

By calculating the number of doses refilled, divided by the number of doses prescribed over a period of up to 365 days.

Question 25

Sherman et al. (2000)

What were doctors asked to estimate?

Answer 25

Whether or not they thought their patient was adhering.

Question 26

Sherman et al. (2000)

Conclusion

Answer 26

Checking prescription refills is accurate and a practical measure and that doctors themselves are not reliable.

Question 27

Blood tests

Ethics regarding blood tests to measure adherence

Answer 27

They are considered invasive, and therefore unethical.

Question 28

Issues and debates

How does Chung and Naya’s study have low validity?

Answer 28

Participants knew adherence was being measured, so may have adhered more than normal (social desirability etc.).

Question 29

Issues and debates

Why does Chung and Naya’s study have ethical issues?

Answer 29

They did not inform participants of the Track Cap being used- deceiving them.

Question 30

Issues and debates

Why does Riekart and Droter’s study have ethical issues?

Answer 30

They used data from non-consenters without their permission.