Multiple Adherence Tool Evaluation Study (MATES)

Medication nonadherence is a common problem, resulting in significant human and economic cost, which can be a challenge to identify and resolve in practice. Adherence tools have been developed to assist health care providers with managing medication nonadherence; however, there is a need to develop a literature base for using adherence tools effectively.

To (a) describe the experiences and perspectives of pharmacists and student pharmacists using the Adherence Estimator (AE) and Drug Adherence Work-up (DRAW) tools and (b) describe medication nonadherence issues identified via use of the AE and DRAW tools in community pharmacies and outpatient clinics.

A practice-based study involving 6 primary care clinics and 4 community pharmacies in Iowa and Michigan was conducted. Each adherence tool was administered approximately 20 times by pharmacists or student pharmacists to patients at each site, using a crossover design with randomization to the initial tool. Sites determined how to incorporate tools into workflow and how to select patients. Data from completed tools were analyzed descriptively. Data from an online survey completed by tool administrators about their experiences and suggestions were analyzed thematically.

Sites submitted 209 AE and 179 DRAW tools. Half of patients with a completed AE had at least 1 medication of medium or high risk of nonadherence, and 19% had at least 1 medication of high risk. For DRAW, 82% of patients reported at least 1 yes answer for reasons for nonadherence, and 58% reported 2. On average, the AE tool took 6.9 minutes, and the DRAW tool took 9.3 minutes. Forty-four surveys were submitted (20 community and 24 clinic). Two themes emerged from the open-ended responses: tool benefits and translating tools into practice. While the tools were useful for identifying specific reasons for nonadherence and promoting dialogue, they required additional time and effort from both patients and pharmacists. Health literacy, patient reluctance to discuss nonadherence, AE scaling, and DRAW length were voiced as concerns.

Both tools were useful for uncovering specific reasons for medication nonadherence in 5-10 minute encounters, but barriers exist to incorporating such tools into busy workflows.