Multimethod Approach Identifies Pharmacologic Nonadherence

An assessment of pharmacy refill data and technology measures can improve accurate identification of nonadherence among chronic kidney disease (CKD) patients, claims a new study.

Researchers at Johns Hopkins University (JHU; Baltimore, MD, USA), the U.S. National Institutes of Health (NIH, Bethesda, MD, USA), and other institutions conducted a study involving 87 adolescents and young adults (AYA) with CKD prescribed antihypertensive medication, their caregivers, and 17 participating medical providers. Five adherence measures were used, including healthcare provider report, AYA report, caregiver report, electronic medication monitoring (MEMS) pillboxes, and pharmacy refill data.

The results revealed that both healthcare providers and electronic pillboxes classified 34.5% of patients as nonadherent, although they disagreed about which patients were actually nonadherent. AYA patient reports, caregiver reports, and pharmacy refill data all classified 50-61% of the patients as nonadherent. Combining provider reports and pharmacy refill data, the researchers found, led to the most balanced sensitivity and negative predictive power. The study was published in the December 2018 issue of Pediatric Nephrology.

"In general, providers are already doing assessments of patients' adherence levels, and most clinical practices have the ability to access pharmacy refill data, so this is a very feasible thing to start doing in a clinical setting,” said lead author Cozumel Pruette, MD, of JHU Children's Center. “We can't say what other specific populations our findings apply to, but it's likely generalizable that some kind of multi-modal approach is really the most meaningful in identifying nonadherence and providing us with the greatest level of information to help patients improve their adherence.”

Estimates by the World Health Organization indicate that only about 50% of patients in developed countries follow treatment recommendations. Low rates of adherence for asthma, diabetes, and hypertension are thought to contribute substantially to the human and economic burden of those conditions. Major barriers to compliance include the complexity of modern medication regimens, poor "health literacy" and lack of comprehension of treatment benefits, undiscussed side effects, the cost of prescription medicine, and poor communication or lack of trust between patient and health-care provider.

Related Links:
Johns Hopkins University
U.S. National Institutes of Health