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Assessing adherence to medications: Is there a difference between a subjective method and an objective method, or

Razan I Nassar1, Bandana Saini2, Nathir M Obeidat3

  • 1MSc. Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan. R_nassar@asu.edu.jo.

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Summary

Combining subjective and objective methods for medication adherence assessment identified more non-adherent patients. This supports using both the Adherence to Asthma Medication Questionnaire (AAMQ) and pharmacy refill records together.

Keywords:
adherence to medicationasthmapharmacy refill recordsquestionnaire

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Area of Science:

  • Pharmacology
  • Clinical Medicine
  • Health Outcomes Research

Background:

  • Medication adherence is crucial for effective treatment, particularly in chronic conditions like asthma.
  • Global Initiative for Asthma (GINA) guidelines recommend using both subjective and objective measures for adherence assessment.
  • Existing methods for assessing medication adherence include subjective patient self-reports and objective pharmacy refill data.

Purpose of the Study:

  • To evaluate the effectiveness of subjective (Adherence to Asthma Medication Questionnaire - AAMQ) and objective (pharmacy refill records) methods in assessing medication adherence separately.
  • To determine the adherence assessment rate when combining both subjective and objective methods.
  • To quantify the agreement between the AAMQ and pharmacy refill records using Cohen's kappa coefficient.

Main Methods:

  • Participants completed the Adherence to Asthma Medication Questionnaire (AAMQ).
  • Pharmacy refill records were retrospectively audited over twelve months, calculating the Medication Possession Ratio (MPR).
  • Data were analyzed using SPSS, with Cohen's kappa (κ) assessing agreement between methods.

Main Results:

  • The AAMQ identified 61.4% of non-adherent patients, versus 34.3% identified by pharmacy refill records.
  • Combining both methods identified 80.0% of non-adherent patients, a higher rate than either method alone.
  • Agreement between the AAMQ and pharmacy refill records was low (35.7% agreement, low correlation).

Conclusions:

  • A combined approach using the AAMQ and pharmacy refill records is more effective in identifying non-adherent patients than using either method individually.
  • These findings support the Global Initiative for Asthma (GINA) recommendation for simultaneous use of subjective and objective adherence measures.
  • The study highlights the limitations of individual adherence assessment methods and the benefit of a combined strategy.