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What is a missed dose? Implications for construct validity and patient adherence.
A P Sankar1, D C Nevedal, S Neufeld
1Department of Anthropology, Institute of Gerantology, Wayne State University, Detroit, Michigan 48202, USA. asankar@wayne.edu
AIDS Care
|June 19, 2007
Summary
Patient and clinician understanding of missed medication doses differs significantly. This impacts adherence assessments and patient-physician communication, highlighting the need for clearer definitions in healthcare.
Area of Science:
- Medical adherence research
- Patient-physician communication
- HIV/AIDS treatment outcomes
Background:
- The definition of a 'missed dose' is crucial for evaluating medication adherence.
- Limited research exists on how patients and clinicians conceptualize missed doses.
- Understanding concordance/discordance between these groups is essential.
Purpose of the Study:
- To explore patient and clinician conceptualizations of missed doses.
- To identify discrepancies in understanding between patients and healthcare providers.
- To assess the implications of these differences on adherence measurement and patient care.
Main Methods:
- Conducted semi-structured interviews with 45 HIV-positive African American adults on HAART (Highly Active Antiretroviral Therapy).
- Interviewed 17 of their clinicians to compare perspectives.
- Analyzed interview data to identify variations and agreements in missed dose definitions.
Main Results:
- Significant variability in 'missed dose' conceptions was found among both patients and clinicians.
- Patients generally held stricter definitions of a missed dose than clinicians.
- Disagreements were noted on what constitutes a missed dose (e.g., 6-hour delay) and the appropriate response (e.g., skipping doses).
Conclusions:
- Differences in missed dose conceptualizations challenge the validity of self-report adherence measures.
- Patient adherence behaviors may be influenced by their unique understanding of missed doses.
- Improved patient-physician communication regarding missed doses is vital for effective clinical management and relationships.
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