Concordance of Adherence Measurement Using Self-Reported Adherence Questionnaires and Medication Monitoring Devices

Abstract

The primary objective of this review was to identify and examine the literature on the association between medication adherence self-reported questionnaires (SRQs) and medication monitoring devices. The primary literature search was performed for 1980-2009 using PubMed, PubMed In Process and Non-Indexed, Ovid MEDLINE, Ovid MEDLINE In-Process, PsycINFO (EBSCO), CINAHL (EBSCO), Ovid HealthStar, EMBASE (Elsevier) and Cochrane Databases and using the following search terms: 'patient compliance', 'medication adherence', 'treatment compliance', 'drug monitoring', 'drug therapy', 'electronic', 'digital', 'computer', 'monitor', 'monitoring', 'drug', 'drugs', 'pharmaceutical preparations', 'compliance' and 'medications'. We identified studies that included SRQs and electronic monitoring devices to measure adherence and focused on the SRQs that were found to be moderately to highly correlated with the monitoring devices. Of the 1679 citations found via the primary search, 41 full-text articles were reviewed for correlation between monitoring devices and SRQs. A majority (68%) of articles reported high (27%), moderate (29%) or significant (12%) correlation between monitoring devices (37 using Medication Event Monitoring System [MEMS®] and four using other devices) and SRQs (11 identified and numerous other unnamed SRQs). The most commonly used SRQs were the Adult/Pediatric AIDS Clinical Trial Group (AACTG/PACTG; 24.4%, 10/41) followed by the 4-item Morisky (9.8%, 4/41), Brief Medication Questionnaire (9.8%, 4/41) and visual analogue scale (VAS; 7.3%, 3/41). Although study designs differed across the articles, SRQs appeared to report a higher rate of medication adherence (+14.9%) than monitoring devices. In conclusion, several medication adherence SRQs were validated using electronic monitoring devices. A majority of them showed high or moderate correlation with medication adherence measured using monitoring devices, and could be considered for measuring patient-reported adherence prospectively.

Suboptimal inhaler medication adherence and incorrect technique are common among chronic obstructive pulmonary disease patients

“…33 Furthermore, there is no universally accepted GOLD standard for measuring medication adherence since all methods have certain limitations. 34 The lack of consistency in the results of studies evaluating clinical variables associated with medication adherence suggests that there are possibly a multitude of factors that are different across study populations which affect the self-reporting of adherence to COPD medications. Another limitation is the utilization of checklists for inhaler technique.…”

Self-report measures of medication adherence behavior: recommendations on optimal use

“…A review of 41 studies of the agreement between adherence self-report measures and EDM devices identified 19 publications that failed to name or describe the particular self-report measure used in the study; these studies showed significantly lower correspondence between self-report and electronically monitored adherence when compared with studies that used named, standardized self-report measures [55]. With many validated self-report scales available for clinical or research use, there are sound options from which to choose (see Appendix).…”

“…In a review of 41 medication adherence studies, Shi and colleagues [55] determined that a majority of studies (68 %) report correlations between self-report and EDM adherence measures that are either high (27 %), moderate (29 %), or low yet statistically significant (12 %). A related metaanalysis estimated that the pooled correlation coefficient between self-report and electronically monitored adherence was 0.45 (95 % CI, 0.34-0.56) [56].…”

Key Barriers to Medication Adherence in Survivors of Strokes and Transient Ischemic Attacks

“…40 Stroke/TIA history was also based on self-report and was not confirmed by review of medical records; this may have led to the inclusion of some participants who did not have a cerebrovascular event. Another limitation is that the inclusion of a large number of low income African Americans and Hispanic participants may limit the generalizability of our findings to other study populations.…”