1 / 17

Measuring Adherence

Measuring Adherence. Jonathan Shuter, M.D. Treatment Adherence Network Meeting 2/27/01. Measuring Adherence--One Extreme.

makelina
Download Presentation

Measuring Adherence

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Measuring Adherence Jonathan Shuter, M.D. Treatment Adherence Network Meeting 2/27/01

  2. Measuring Adherence--One Extreme • “I firmly believe that if the whole materia medica as now used could be sunk to the bottom of the sea, it would be all the better for mankind--and all the worse for the fishes.” 1860: Oliver Wendell Holmes to the Massachusetts Medical Society

  3. Measuring Adherence--The Other Extreme D.O.T.

  4. Measuring Adherence--The Middle Ground • Methods that quantify missed and taken doses • Methods that measure physiologic effects • Methods that assess systemic blood levels of drug

  5. Cheap Correlated with virologic outcomes (report of non-adherence is more reliable than report of adherence) Overestimates adherence Self-Report Pro’s Con’s

  6. Clinician-Estimated Adherence Pro’s Con’s • Cheap • Most poorly correlated of all measures with actual adherence PROVIDERS ARE TERRIBLE JUDGES OF ACTUAL ADHERENCE AND OF THEIR PATIENTS’ ABILITY TO ADHERE!

  7. Pill Counts Pro’s Con’s • Cheap • Useful adjunct to self-report • Overestimates adherence • “Pill dumping” • Time consuming • Casts provider in role of medication monitor, not ally/advocate

  8. Pharmacy Records Pro’s Con’s • Cheap • Useful adjunct to self-report • Cannot stand alone as adherence measurement method • One patient may use many pharmacies • Picking up prescriptions does not equate with taking medications • Patients may have other sources of medications

  9. Electronic Monitoring Pro’s Con’s • Best correlation with virologic outcomes • Data is available in a computer accessible format • Allows more detailed view of non-adherence patterns (weekends, nighttime, etc.) • Expensive • Poor patient acceptance • Not infallible (patients can open bottle and not take pill) • Not compatible with pillbox • Usually only measures one medication

  10. Measuring Adherence--The Middle Ground • Methods that quantify missed and taken doses • Methods that measure physiologic effects • Methods that assess systemic blood levels of drug

  11. Indirect Laboratory Markers • AZT=========> Increased MCV • ddI==========> Increased uric acid • Indinavir======> Increased bilirubin

  12. Laboratory Markers • Viral load • CD4 • Genotypic/phenotypic resistance

  13. Measuring Adherence--The Middle Ground • Methods that quantify missed and taken doses • Methods that measure physiologic effects • Methods that assess systemic blood levels of drug

  14. Plasma Levels Pro’s Con’s • Correlates with virologic outcomes • Only method that ensures that the patient actually ingested the drug • May allow insight into absorption or drug interaction problems • Very expensive • Levels are extremely variable • Only provides information about the last dose

  15. Montefiore Data

  16. Montefiore Data • 30/106 (28.3%) patients prescribed ART responded “Never” [miss medications], every time they were interviewed. • These patients are not distinguished by any specific characteristic measured in the study. There are trends toward underrepresentation of females and IDUs in this group. • Analyzed variables include age, gender, ethnicity, HIV risk behavior, AIDS, adverse effects, and depression score.

  17. Conclusions • There is no perfect method or combination of methods available to measure adherence • Nevertheless, numerous methods of measurement correlate with virologic outcomes, and thus provide useful information • Some method of adherence measurement should be used for all patients, but decisions regarding which method/s should be individualized

More Related