Personal experiences of electronic measurement of medication adherence in elderly stroke survivors

A systematic review of primary care-focused, self-reported medication adherence tools

BACKGROUND

Clinician recognition of nonadherence is generally low. Tools that clinicians have used to assess medication adherence are self-reported adherence instruments that ask patients questions about their medication use experience. There is a need for more structured reviews that help clinicians comprehensively distinguish which tool might be most useful and valuable for their clinical setting and patient populations.

OBJECTIVES

This systematic review aimed to (1) identify validated, self-reported medication adherence tools that are applicable to the primary care setting and (2) summarize selected features of the tools as an assessment of clinical feasibility and applicability.

METHODS

The investigators systematically reviewed MEDLINE via Ovid, Embase via Ovid, International Pharmaceutical Abstracts, and CINAHL from inception to December 1, 2020. Investigators independently screened 3394 citations, identifying 43 articles describing validation parameters for 25 unique adherence tools. After screening each tool, 17 tools met the inclusion criteria and were qualitatively summarized.

RESULTS

Findings highlight 25 various tool characteristics (i.e., descriptions, parameters and diseases, measures and validity comparators, and other information), which clinicians might consider when selecting a self-reported adherence tool with strong measurement validity that is practical to administer to patients. There was much variability about the nature and extent of adherence measurement. Considerable variation was noted in the objective measures used to correlate to the self-reported tools' measurements. There were wide ranges of correlation between self-reported and objective measures. Several included tools had relatively low to moderate criterion validities. Many manuscripts did not describe whether tools were associated with costs, had copyrights, and were available in other languages; how much time was required for patients to complete self-report tools; and whether patient input informed tool development.

CONCLUSION

There is a critical need to ensure that adherence tool developers establish a key list of tool characteristics to report to help clinicians and researchers make practical comparisons among tools.

Impact of a SystemCHANGE™ Intervention on Medication Adherence in Older Adults With Heart Failure: A Feasibility Study

The purpose of the current study was to examine the feasibility and acceptability of a SystemCHANGE™ intervention in improving medication adherence in older adults with heart failure (HF). Adults age ≥50 years with HF who self-administered diuretics were screened for 2 months using electronic monitoring to determine baseline adherence scores. Participants were randomized into the SystemCHANGE™ or attention-control group if adherence scores were <88%. The SystemCHANGE™ intervention focuses on changing the individual's environment by including medication taking into existing routines, receiving support from individuals who impact routines, and using small experiments with feedback. Challenges were noted by participants in using the electronic medication monitor technology during the screening phase. Lessons learned from this study emphasize the need to revise recruitment procedures and include multiple sites. Education and counseling should be adapted to the cognitive level of the participant and address technology challenges. [Journal of Gerontological Nursing, 45(4), 15-19.].

Assessing adherence to multiple medications and in daily life among patients with multimorbidity

OBJECTIVE

Chronic conditions often require multiple medication intake. However, past research has focused on assessing overall adherence or adherence to a single index medication only. This study explored adherence measures for multiple medication intake, and in daily life, among patients with multiple chronic conditions (i.e. multimorbidity).

DESIGN

Eighty-four patients with multimorbidity and multiple-medication regimens completed three monthly panel questionnaires. A randomly assigned subsample additionally completed a 30-day daily diary.

MAIN OUTCOME MEASURE

The Non-Adherence Report; a brief self-report measure of adherence to each prescribed medication (NAR-M), and in daily life. We further assessed the Medication Adherence Report Scale (MARS), and a subsample of participants were randomised to electronic adherence monitoring.

RESULTS

The NAR-M indicated M = 94.7% adherence at Time 1 (SD = 9.3%). The NAR-M was significantly correlated with the MARS (r_t1 = .52, r_t2 = .57, and r_t3 = .65; p < .001), and in tendency with electronically assessed adherence (r_t2 = .45, r_t3 = .46, p < .10). Variance components analysis indicated that between-person differences accounted for 10.2% of the variance in NAR-M adherence rates, whereas 22.9% were attributable to medication by person interactions.

CONCLUSION

This study highlights the importance and feasibility of studying adherence to multiple medications differentially, and in daily life. Future studies may use these measures to investigate within-person and between-medication differences in adherence.