This week we are wrapping up our 3-part series on patient adherence, which as we’ve emphasized, is a growing public health concern. In our first two pieces, we talked about the different types of non-adherence and its consequences and ways to help improve patient adherence.
For a treatment to be successful the medication regimen needs to be effective, but it can only be effective if patients are not just taking their medications but are taking them as prescribed. Otherwise, the result is poor outcomes and decreased quality of life.
While it’s difficult to understand the full breadth of this problem, there are common, validated methods – direct and indirect – that can be used to measure treatment adherence. However, both have advantages and disadvantages that should be fully understood and taken into consideration when choosing a suitable method.
Measurement Methods
According to the U.S. National Library of Medicine National Institutes of Health, adherence is usually measured over a period of time, is typically reported as a percentage, and offers information about dose taking behavior in relation to what was prescribed.
Here is a brief overview of methods that measure different aspects of treatment adherence including what they’re measuring and the advantages and disadvantages of each.
| DIRECT METHOD | Measurement of Drug/Metabolite Levels. | This method measures the concentration of the drug/metabolite. While this method is accurate, objective and helps prove the ingestion of the drug, it is invasive with inter-individual differences. |
| INDIRECT METHODS | Pill Count | This is a simple method that measures the number of doses missed and is mostly used in clinical trials. However, the downside to this method is there is no evidence that the medication was ingested. |
| Electronic Databases | This method measures Medication Possession Ration (MPR) & Proportion of Days Covered (PDC). This is an inexpensive, non-invasive and easy-to-use method. In fact, patients aren’t aware they are being monitored. One downside to this method is, although there is evidence of the drug being dispensed, there is no way of knowing if the medication was ingested. | |
| Self-Reported | This method such as questionnaires, visual analog scales, etc., measures a value that is interpreted regarding a pre-established cut-off point. While this method is easy to use and is inexpensive, it can overestimate adherence, is subjective, and is influenced by recall or reporting bias. | |
| Electronic Monitoring Systems | This method measures overall percentage of doses taken and the dosing regimen. This is an objective approach and provides additional information on the degree of adherence, which tends to be one of the most accurate methods. However, the patient is aware of the evaluation and there is no actual evidence that the medication was ever ingested. |
What does all this mean?
There is no silver bullet for measuring patient adherence. However, choosing a combination of at least two methods, will give you simple, accurate and inexpensive ways to gain supplementary information about the patterns, beliefs and barriers of adherence.
One easy way to help improve adherence rates is to offer in house medication dispensing. This allows you to make sure your patients are not only getting their medication, but that they understand, why it’s being prescribed and when and how to take it.
If you’re not currently set up to provide this value-added service to your patients, Pharma Pac can help you get set up in three easy steps. Click here to get started.
Sources: U.S. National Library of Medicine National Institutes of Health