Abstract
BackgroundThere is a recognised need to build primary care medication adherence services which are tailored to patients' needs. Continuous quality improvement of such services requires a regular working method of measuring adherence in order to monitor effectiveness. Self report has been considered the method of choice for clinical use; it is cheap, relatively unobtrusive and able to distinguish between intentional and unintentional non-adherence, which have different underlying causes and therefore require different interventions. A self report adherence measure used in routine clinical practice would ideally be brief, acceptable to patients, valid, reliable, have the ability to distinguish between different types of non-adherence and be able to be completed by or in conjunction with carers where necessary.MethodsWe systematically reviewed the literature in order to identify self report adherence measures currently available which are suitable for primary care and evaluate the extent to which they met the criteria described above. We searched the databases Medline, Embase, International Pharmaceutical s, Pharmline, CINAHL, PsycINFO and HaPI to identify studies reporting the development, validation or reliability of generic adherence measures. One reviewer screened all abstracts and assessed all relevant full text articles obtained and a second reviewer screened/assessed 10% to check reliability.ResultsFifty eight measures were identified. While validation data were presented in support of the vast majority of self reported measures (54/58), data for a relatively small number of measures was presented for reliability (16/58) and time to complete (3/58). Few were designed to have the ability to be completed by or in conjunction with carers and few were able to distinguish between different types of non-adherence, which limited their ability be used effectively in the continuous improvement of targeted adherence enhancing interventions. The data available suggested that patients find it easier to estimate general adherence than to report a specific number of doses missed. Visual analogue scales can be easier for patients than other types of scale but are not suitable for telephone administration.ConclusionsThere is a need for a measure which can be used in the routine continual quality monitoring of adherence services.
Highlights
There is a recognised need to build primary care medication adherence services which are tailored to patients’ needs
A recent paper that mapped the quality of medicines use in primary care estimated that only between four and 21% of patients achieve effective, error free care, and that an improvement in adherence would be the most significant area to target to improve medicine use [5]
In order to continually improve quality of services provided to a population, there is a need to have a regular working method to monitor the effectiveness of the service and for pharmacists and Primary Care Trusts to evaluate the effectiveness of changes to the service
Summary
There is a recognised need to build primary care medication adherence services which are tailored to patients’ needs. Continuous quality improvement of such services requires a regular working method of measuring adherence in order to monitor effectiveness. A self report adherence measure used in routine clinical practice would ideally be brief, acceptable to patients, valid, reliable, have the ability to distinguish between different types of non-adherence and be able to be completed by or in conjunction with carers where necessary. In order to build effective targeted adherence services, a simple, valid and reliable method for detecting the prevalence and type of non-adherence to medicines is needed [6]. In order to continually improve quality of services provided to a population, there is a need to have a regular working method to monitor the effectiveness of the service and for pharmacists and Primary Care Trusts (local state funded primary care management organisations) to evaluate the effectiveness of changes to the service. In order to monitor adherence, understand the reasons for non-adherence and improve the effectiveness of adherence services there is a need for frequent, regular measurements which are not very time consuming to make
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