Adherence to oral tamoxifen: a comparison of patient self-report, pill counts, and microelectronic monitoring.

1993 ◽  
Vol 11 (6) ◽  
pp. 1189-1197 ◽  
Author(s):  
D M Waterhouse ◽  
K A Calzone ◽  
C Mele ◽  
D E Brenner
Keyword(s):  
Patient Adherence ◽  
Tamoxifen Therapy ◽  
Self Report ◽  
Adherence Behavior ◽  
Event Monitoring ◽  
Dosing Interval ◽  
Drug Packaging ◽  
Continuous Record ◽  
Pill Counts ◽  
Adherence Monitoring

PURPOSE Recent innovations allow the integration of microelectronics into drug packaging, providing a continuous record of the interactions of the patient with the drug package. We hypothesized that adherence to oral tamoxifen, as measured by a pressure-activated microelectronic monitoring device, would be significantly discrepant from traditional measures of patient adherence, ie, patient self-report (SR) and pill counts (PCs). PATIENTS AND METHODS Twenty-six patients receiving oral tamoxifen therapy were assessed by patient SR, PCs, and Medication Event Monitoring System (MEMS; Aprex Corp, Fremont, CA) microelectronic monitoring. A microprocessor in the MEMS cap recorded each opening as a presumptive dose, listing the date, time, and duration of opening for later retrieval on a microcomputer. Patients were not informed that their adherence was to be monitored electronically or that PCs would be performed. RESULTS A total of 2,102 days (70.1 months) of tamoxifen therapy were monitored; patients were monitored for a mean of 2.92 months of tamoxifen therapy. SR adherence to oral tamoxifen was significantly higher than that suggested by either PCs (SR missed doses only v PC, P = .008) or MEMS adherence monitoring (SR missed doses only v MEMS missed doses only, P = .005; SR dosing-interval errors only v MEMS dosing-interval errors only, P < .0001; SR all dosing errors v MEMS all dosing errors, P < .0005). PC data also suggested significantly higher adherence rates than MEMS monitoring. CONCLUSION Microelectronic adherence monitoring provides both confirmatory and complimentary data regarding adherence behavior, while also allowing for the evaluation of patterns of nonadherence. Patient SRs and PCs likely overestimate the degree to which patients adhere to their tamoxifen regimen.

scholarly journals Predicting and Influencing Voice Therapy Adherence Using Social–Cognitive Factors and Mobile Video

2015 ◽  
Vol 24 (2) ◽  
pp. 164-176 ◽  
Author(s):  
Eva van Leer ◽  
Nadine P. Connor
Keyword(s):  
Therapeutic Alliance ◽  
Self Efficacy ◽  
Social Cognitive ◽  
Patient Adherence ◽  
Goal Commitment ◽  
Self Report ◽  
Cognitive Factors ◽  
Voice Therapy ◽  
Adherence Behavior ◽  
Treatment Onset

PurposePatient adherence to voice therapy is an established challenge. The purpose of this study was (a) to examine whether adherence to treatment could be predicted from three social–cognitive factors measured at treatment onset: self-efficacy, goal commitment, and the therapeutic alliance, and (b) to test whether the provision of clinician, self-, and peer model mobile treatment videos on MP4 players would influence the same triad of social cognitive factors and the adherence behavior of patients.MethodForty adults with adducted hyperfunction with and without benign lesions were prospectively randomized to either 4 sessions of voice therapy enhanced by MP4 support or without MP4 support. Adherence between sessions was assessed through self-report. Social cognitive factors and voice outcomes were assessed at the beginning and end of therapy. Utility of MP4 support was assessed via interviews.ResultsSelf-efficacy and the therapeutic alliance predicted a significant amount of adherence variance. MP4 support significantly increased generalization, self-efficacy for generalization, and the therapeutic alliance. An interaction effect demonstrated that MP4 support was particularly effective for patients who started therapy with poor self-efficacy for generalization.ConclusionAdherence may be predicted and influenced via social–cognitive means. Mobile technology can extend therapy to extraclinical settings.

scholarly journals Video chat technology to remotely quantify dietary, supplement and medication adherence in clinical trials

2016 ◽  
Vol 116 (9) ◽  
pp. 1646-1655 ◽  
Author(s):  
Courtney M. Peterson ◽  
John W. Apolzan ◽  
Courtney Wright ◽  
Corby K. Martin
Keyword(s):  
Medication Adherence ◽  
Online Survey ◽  
Self Report ◽  
Rater Agreement ◽  
Monitoring Methods ◽  
Video Chat ◽  
Pill Counts ◽  
Survey Results ◽  
Adherence Monitoring ◽  
Study Participants

AbstractWe conducted two studies to test the validity, reliability, feasibility and acceptability of using video chat technology to quantify dietary and pill-taking (i.e. supplement and medication) adherence. In study 1, we investigated whether video chat technology can accurately quantify adherence to dietary and pill-taking interventions. Mock study participants ate food items and swallowed pills, while performing randomised scripted ‘cheating’ behaviours to mimic non-adherence. Monitoring was conducted in a cross-over design, with two monitors watching in-person and two watching remotely by Skype on a smartphone. For study 2, a twenty-two-item online survey was sent to a listserv with more than 20 000 unique email addresses of past and present study participants to assess the feasibility and acceptability of the technology. For the dietary adherence tests, monitors detected 86 % of non-adherent events (sensitivity) in-person v. 78 % of events via video chat monitoring (P=0·12), with comparable inter-rater agreement (0·88 v. 0·85; P=0·62). However, for pill-taking, non-adherence trended towards being more easily detected in-person than by video chat (77 v. 60 %; P=0·08), with non-significantly higher inter-rater agreement (0·85 v. 0·69; P=0·21). Survey results from study 2 (n 1076 respondents; ≥5 % response rate) indicated that 86·4 % of study participants had video chatting hardware, 73·3 % were comfortable using the technology and 79·8 % were willing to use it for clinical research. Given the capability of video chat technology to reduce participant burden and outperform other adherence monitoring methods such as dietary self-report and pill counts, video chatting is a novel and promising platform to quantify dietary and pill-taking adherence.

Noncompliance May Render Migraine Prophylaxis Useless, But Once-Daily Regimens Are Better

Cephalalgia ◽  
1998 ◽  
Vol 18 (1) ◽  
pp. 52-56 ◽  
Author(s):  
WM Mulleners ◽  
TE Whitmarsh ◽  
TJ Steiner
Keyword(s):  
Migraine Prophylaxis ◽  
Monitoring Systems ◽  
Event Monitoring ◽  
Once Daily ◽  
Dosing Interval ◽  
Significant Difference ◽  
Pill Counts ◽  
Headache Clinic ◽  
Expected Compliance ◽  
Drug Prophylaxis

Medicines work better if taken, which must be true of migraine prophylaxis. There is evidence that compliance with regular medication can be badly deficient. To assess how serious the problem might be in routine migraine management, we undertook a covert observational 2-month survey in a specialist headache clinic using objective measures of compliance. Subjects were 38 patients needing prophylaxis with medication prescribed once (od), twice (bd), or three times daily (tds). Medication was dispensed, unknown to them, in Medication Event Monitoring Systems (MEMS) to record openings in real time. Number, timing, and pattern of actual openings were compared with what was expected. Compliance rates averaged 66%, although returned pill counts indicated 91%. A substantial and significant difference was shown between od and bd or tds regimens. Measures of dosing interval—used-on-schedule rate and therapeutic coverage—averaged between 44% and 71%. Once-daily treatment was associated with a used-on-schedule rate more than double those of multiple daily dosing, but still only 66%. We conclude that routine use of drug prophylaxis in migraine may be so seriously undermined by poor compliance that it has little chance of efficacy. Returned-pill counting is inadequate for compliance assessment.

scholarly journals Real-Time Electronic Adherence Monitoring is Feasible, Comparable to Unannounced Pill Counts, and Acceptable

2011 ◽  
Vol 16 (2) ◽  
pp. 375-382 ◽  
Author(s):  
Jessica E. Haberer ◽  
Gregory K. Robbins ◽  
Michele Ybarra ◽  
Alexandra Monk ◽  
Kathleen Ragland ◽  
...  
Keyword(s):  
Real Time ◽  
Pill Counts ◽  
Adherence Monitoring

scholarly journals Simultaneous Use of Two Different Tools to Assess Compliance with Antiepileptic Drugs: Experience in A Community-Based Study

2020 ◽  
Vol 11 (04) ◽  
pp. 636-639
Author(s):  
Paramjit Singh ◽  
Kanchan Gupta ◽  
Gagandeep Singh ◽  
Sandeep Kaushal
Keyword(s):  
Head Injuries ◽  
Emergency Department Visits ◽  
Pill Count ◽  
Self Report ◽  
Chi Square ◽  
Breakthrough Seizure ◽  
Adherence Scale ◽  
Pill Counts ◽  
Chi Square Test ◽  
Relationship Of

Abstract Objective Antiepileptic drug (AED) therapy remains the primary form of treatment for epilepsy, noncompliance to which can result in breakthrough seizure, emergency department visits, fractures, head injuries, and increased mortality. Various tools like self-report measures, pill-counts, medication refills, and frequency of seizures can assess compliance with varying extent. Thus, assessment of compliance with AEDs is crucial to be studied. Materials and Methods Compliance was assessed using pill-count and Morisky medication adherence scale (MMAS) during home visits. A pill-count (pills dispensed–pills remaining)/(pills to be consumed between two visits) value of 0.85 to ≤1.15 was recorded as appropriate compliance. Underdose (<0.85) and overdose (>1.15) was labeled as noncompliance. Score of 1 was given to each positive answer in MMAS. Score of ≥1 was labeled as noncompliance.Statistical analysis: Relationship of demographic factors between compliant and noncompliant patients was analyzed using Chi-square test (SPSS version 21.0, IBM). Rest of the data was analyzed with the help of descriptive statistics using Microsoft Excel. p< 0.05 was considered statistically significant. Results Out of 105 patients, 54 patients were noncompliant with both pill-count and MMAS. 10 patients were noncompliant with pill-count only, while 10 were noncompliant with MMAS. Conclusion Both tools complement each other when used in combination, as use of a single tool was not able to completely detect compliance.

Abstract P208: Transient Ischaemic Attack: How the Patient Perceives it

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Mary J MacLeod ◽  
Ali Abdullah
Keyword(s):  
Secondary Prevention ◽  
Transient Ischaemic Attack ◽  
Patient Adherence ◽  
Behavioural Change ◽  
Illness Perception ◽  
Personal Control ◽  
Self Report ◽  
Minor Stroke ◽  
Medical Attention ◽  
Ischaemic Attack

Background: The risk of stroke after Transient Ischaemic Attack (TIA) is 8-11 % within a month. Rapid assessment and early use of preventative therapies can reduce this risk by 80-90%. Many patients do not seek timely medical attention, and may minimise their symptoms. The purpose of this study was to assess patients' perception of the significance of TIA/ minor stroke, and their beliefs and attitudes to secondary prevention interventions. Methods: 120 patients with a recent TIA/minor stroke were given a questionnaire after clinic/ward review. This included the validated Brief Illness Perception Questionnaire (Brief-IPQ: scores 0-10), and Beliefs about Medicines Questionnaire (BMQ: scores 5-25). Patient adherence to secondary prevention medications was assessed by self-report. Results: There was a 56% return rate. Within the brief-IPQ, patients had a mid score for perceived consequences of their event (4.88 (sd2.67)). Only 22% took urgent action at the time of the event. 60% were persuaded to take action by family or friends. Patients scored the midpoint for emotional distress (4.9 (sd 3.4)) and felt they could not exert personal control (4.0(3.2)). They did believed treatment would control their condition (7.7(2.1)). The majority of patients (86.3%) believed in the necessity of medication, with mean necessity score of 18.36(3.5). 14% reported concerns about becoming dependent upon medications and the potential adverse consequences of taking medication. 78% of patients said they complied with their treatment. Conclusions: Patients may not regard TIA or minor stroke as having important implications for their future health. Many only seek medical advice as a result of external pressure. Patients do not feel they have personal control over the condition, but believe medication is necessary and beneficial. These findings will inform strategies for education and behavioural change interventions in people at risk of or who have had a TIA/minor stroke

Correspondence Between Objective and Self-reported Endocrine Therapy Adherence Among Women With Breast Cancer

2018 ◽  
Vol 53 (9) ◽  
pp. 849-857
Author(s):  
Emma E Bright ◽  
Annette L Stanton
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Breast Cancer Survivors ◽  
Self Report ◽  
Event Monitoring ◽  
Therapy Adherence ◽  
The Past ◽  
Hormone Receptor Positive ◽  
Coping Processes ◽  
Objective Indicators

AbstractBackgroundAmong the approximately 70% of women with hormone receptor-positive breast cancer, endocrine therapies lower the likelihood of recurrence. Nonadherence to endocrine therapy predicts lower survival.PurposeWe examined concordance between self-reported and objective indicators of adherence and predictors of over-reporting endocrine therapy adherence among survivors of breast cancer.MethodsWomen with breast cancer (N = 112) receiving their initial endocrine therapy prescription completed three assessments at prescription initiation (Time 1), 1 month (Time 2), and 4 months later (Time 3). At Time 1, participants were provided a medication event monitoring system (MEMS) cap to assess adherence; it was collected at Time 3. Women completed items regarding self-reported adherence, depressive symptoms, cancer-related coping processes, and the patient–physician relationship.ResultsMEMS was significantly negatively correlated with the self-reported nonadherence measurements of occasionally forgetting (Time 2, ρ = −.29, p < .01; Time 3, ρ = −.24, p < .01), nonadherence in the past week (Time 2, ρ = −.53, p < .01; Time 3, ρ = −.45, p < .01), and nonadherence in an average week in the past month (Time 2, ρ = −.38, p < .01; Time 3, ρ = −.39, p < .01). Concordance in objective and self-reported adherence measures was evident in 83% of women at Time 2 and 73% at Time 3. Older age was significantly associated (p < .01) with discordance.ConclusionsFindings reveal moderate correspondence between objective and self-report measures, with self-report overestimating objective adherence. Clinicians should be aware when treating older breast cancer survivors that they are more likely to over self-report their endocrine therapy adherence.

scholarly journals Returning of antiretroviral medication dispensed over a period of 8 months suggests non-adherence despite full adherence according to real time medication monitoring

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Kennedy Michael Ngowi ◽  
Lydia Masika ◽  
Furaha Lyamuya ◽  
Eva Muro ◽  
Blandina T. Mmbaga ◽  
...  
Keyword(s):  
Viral Load ◽  
Real Time ◽  
Self Report ◽  
Hiv Care ◽  
Trial Participation ◽  
Hiv Viral Load ◽  
Antiretroviral Medication ◽  
Medication Monitoring ◽  
Load Monitoring ◽  
Pill Counts

Abstract Real-time medication monitoring (RTMM) may potentially enhance adherence to antiretroviral treatment (ART). We describe a participant in an ongoing trial who, shortly after completing trial participation, died of cryptococcal meningitis despite high levels of adherence according to self-report, pill-counts and RTMM (> 99%). However, she evidenced consistently high HIV viral load throughout the 48-week study follow-up. Subsequently, her relatives unsolicitedly returned eight months’ dispensed ART medication that she was supposed to have taken. This brief report illustrates the challenges of adherence measurements including RTMM, and reinforces the need to combine adherence assessments with viral load monitoring in HIV care.

Assessment of Sulfonylurea Adherence and Metabolic Control

1995 ◽  
Vol 21 (1) ◽  
pp. 52-57 ◽  
Author(s):  
Barbara J. Mason ◽  
Joy R. Matsuyama ◽  
Sandra G. Jue
Keyword(s):  
Metabolic Control ◽  
Insulin Dependent Diabetes Mellitus ◽  
Self Report ◽  
Dependent Diabetes Mellitus ◽  
Medication Monitoring ◽  
Adherence Assessment ◽  
Values Assessment ◽  
Pill Counts ◽  
Insulin Dependent ◽  
Electronic Medication Monitoring

This study was designed to compare sulfonylurea adherence assessment by providers, patients' self-report, pill counts, and a medication event monitoring system (MEMS-3®) device, and correlate the estimates of metabolic control by provider, patient, and laboratory. Forty-seven outpatient veterans with fair to poor metabolic control of non-insulin-dependent diabetes mellitus were enrolled and received monthly refills of sulfonylurea in vials with a cap containing an electronic medication monitoring microprocessor. Pill counts and fasting plasma glucoses were measured monthly, and glycohemoglobin and a 24-hour diet recall were obtained at 0 and 60 days. Investigators then asked providers and patients to assess adherence and metabolic control. Forty-seven percent were nonadherent to medication using MEMS-3®, 29% using pill counts, 29% using provider assessment, and 31 % using self-report. Thirty-one percent of providers and 53% of patients assessed metabolic control differently than laboratory values. Assessment of medication adherence by provider, patient, and pill counts did not explain metabolic control as closely as assessment by MEMS-3®.

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