Measuring Adherence- (Chung and Naya)

Chung and Naya

Aim: To electronically assess compliance/ adherence with an oral asthma medication.

Method: Field experiment

Participants: 57 asthmatic patients (47 completed it).

Procedure: Patients were told that compliance would be assessed as part of the study however they weren't told about the specifics of the TrackCap. The participants began 12 weeks of treatment with oral asthma medication (pills) to be taken two times a day. Adherence was measured by the TrackCap objectively recording each occasion that patients removed and replaced their bottle caps. The TrackCap recorded each time a patient opened their bottle this provided the researcher with the number of times they opened the bottle and length of time between openings.
The medicine was suppose to be taken twice a day, so a patient was seen to be adhering if the TrackCap was opened twice a day with 8 hours in-between each opening.

Results: 47 patients completed the study with a mean compliance of 80% (compliance being 1- TrackCap openings per number of tablets the patient was told to take and 2- as the difference between  number of tablets dispensed and number returned per number prescribed)
E.g. say if patient prescribed 50 tablets, dispenses 42, therefore would be returning 8.

Mean adherence of 64% (adherence defined as the number of days with two TrackCap events at least 8 hours apart as measured by TrackCap events. High rates of compliance were maintained throughout the trial. Compliance as estimated from return tablet count was slightly higher.

Discussion: The results show that compliance with and adherence to a treatment of an oral, twice daily, maintenance asthma medication is high.

Concept:

Even if its assumed that adherence rates are low, psychologists still ned to consider how adherence can be measured. There are ways of measuring adherence and, as in all psychological research, no perfect research method.

Self-report: Ask the patient and they may tell you how adherent they are. Unfortunately it is a consistent research finding that patients overestimate their adherence to the treatment.

Therapeutic outcome: Is the patient getting better? If, for example a patient is taking the medication for hypertension then we would expect their blood pressure to decrease. However there are a range of factors the could contribute to a change in blood pressure such as an environment change and levels of stress,

Health worker estimates: Ask the doctor and they should be able to estimate how adherent a patient is being. Once again, this method has been found to be very unreliable.

Mechanical methods: A number of devices that have been developed to measure how much medicine is dispensed from a bottle. These devices are expensive and only record how much medicine leaves the bottle and not how much goes into the person.

Biochemical tests: It is possible to use a blood test or urine sample to estimate how adherent a patient has been with their medication. For example, it is possible to estimate adherence with diet in renal patients by measuring the potassium and urea in their blood when they report for their next session of dialysis.

Evaluation:

The sample must have volunteered which makes it ethical. However the sample was ethnocentric as the patients were only from London and may naturally have high adherence as they volunteered to take part. It should be noted not all completed the study, only 47/57 did.

Validity: Slight use of deception- avoids demand characteristics. Conducted over 12 week period which would allow for initial socially desirable behaviours to wear off. Objective measurement