Abstract
BackgroundClinicians have difficulty accurately assessing medication non-adherence within chronic disease care settings. Health information technology (HIT) could offer novel tools to assess medication adherence in diverse populations outside of usual health care settings. In a multilingual urban safety net population, we examined the validity of assessing adherence using automated telephone self-management (ATSM) queries, when compared with non-adherence using continuous medication gap (CMG) on pharmacy claims. We hypothesized that patients reporting greater days of missed pills to ATSM queries would have higher rates of non-adherence as measured by CMG, and that ATSM adherence assessments would perform as well as structured interview assessments.MethodsAs part of an ATSM-facilitated diabetes self-management program, low-income health plan members typed numeric responses to rotating weekly ATSM queries: “In the last 7 days, how many days did you MISS taking your …” diabetes, blood pressure, or cholesterol pill. Research assistants asked similar questions in computer-assisted structured telephone interviews. We measured continuous medication gap (CMG) by claims over 12 preceding months. To evaluate convergent validity, we compared rates of optimal adherence (CMG ≤ 20%) across respondents reporting 0, 1, and ≥ 2 missed pill days on ATSM and on structured interview.ResultsAmong 210 participants, 46% had limited health literacy, 57% spoke Cantonese, and 19% Spanish. ATSM respondents reported ≥1 missed day for diabetes (33%), blood pressure (19%), and cholesterol (36%) pills. Interview respondents reported ≥1 missed day for diabetes (28%), blood pressure (21%), and cholesterol (26%) pills. Optimal adherence rates by CMG were lower among ATSM respondents reporting more missed days for blood pressure (p = 0.02) and cholesterol (p < 0.01); by interview, differences were significant for cholesterol (p = 0.01).ConclusionsLanguage-concordant ATSM demonstrated modest potential for assessing adherence. Studies should evaluate HIT assessments of medication beliefs and concerns in diverse populations.Trial registrationNCT00683020, registered May 21, 2008.
Highlights
Clinicians have difficulty accurately assessing medication non-adherence within chronic disease care settings
As a comparison to a standard clinical and research method for assessing adherence, we investigated the relationship between missed pills reported during a computer-assisted structured interview and continuous medication gap (CMG), hypothesizing that automated telephone self-management (ATSM) would perform as well as an interview
We identified diabetes patients through the San Francisco Department of Public Health (SFDPH) diabetes registry or those with evidence of San Francisco Health Plan (SFHP) claims related to diabetes, followed by confirmation in the SFDPH electronic health record [46]
Summary
Clinicians have difficulty accurately assessing medication non-adherence within chronic disease care settings. In a multilingual urban safety net population, we examined the validity of assessing adherence using automated telephone self-management (ATSM) queries, when compared with non-adherence using continuous medication gap (CMG) on pharmacy claims. Medication adherence can be enhanced by improving patient-centered prescribing and intervening upon barriers to intentional and unintentional non-adherence [16, 17]. This improvement process requires that clinicians and care teams elicit patients’ goals, beliefs and concerns to identify motivations and reduce barriers to taking medications [16, 18,19,20]. Clinicians face time constraints and competing demands that reduce their ability to engage their patients effectively during visits, in resource-challenged safety net settings that serve vulnerable patients [29,30,31]
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