Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA.
Division of Pharmaceutical Outcomes and Policy, University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, NC, USA.
Transl Behav Med. 2021 Feb 11;11(1):104-113. doi: 10.1093/tbm/ibz133.
Consensus on a gold-standard measure of patient medication nonadherence has been elusive, in part because medication nonadherence involves multiple, distinct behaviors across three phases (initiation, implementation, and persistence). To assess these behaviors, multiple measurement approaches may be needed. The purpose of this study was to identify expert-recommended approaches to measuring nonadherence behaviors. Thirty medication nonadherence experts were e-mailed two consecutive surveys. In both, respondents rated their agreement with definitions of nonadherence behaviors and measurement approaches. In the second survey, respondents rated the suitability of each measurement approach for assessing each behavior and identified the optimal measurement approach for each behavior. Consensus was achieved for eight patient medication nonadherence behaviors: not filling initial prescription and not taking first dose (noninitiation); refilling prescription late, missing doses, taking extra doses, taking doses at wrong time, and improperly administering medication (incorrect implementation); and discontinuing medication early (nonpersistence). Consensus was achieved for seven measurement approaches: self-report, prescription fill data, pill count, drug levels, electronic drug monitoring (EDM), smart technology, and direct observation. Self-report questionnaires were most commonly rated "at least somewhat suitable" for measuring behaviors. EDM was rated as optimal for measuring missing doses, taking extra doses, and taking doses at the wrong time. Prescription fill data were rated as optimal for not filling initial prescription, refilling late, and discontinuing. Direct observation was rated as optimal for measuring improper administration. Suitable and optimal measurement approaches varied across nonadherence behaviors. Researchers should select the measurement approach best suited to assessing the behavior(s) targeted in their research.
对于患者用药依从性的金标准衡量指标，尚未达成共识，部分原因是用药依从性涉及三个阶段（起始、执行和维持）的多种不同行为。为了评估这些行为，可能需要多种测量方法。本研究旨在确定专家推荐的测量不依从行为的方法。向 30 名用药不依从性专家发送了两封连续的电子邮件调查。在这两封调查中，受访者对不依从行为和测量方法的定义表示了认同。在第二次调查中，受访者对每种测量方法评估每种行为的适用性进行了评分，并确定了每种行为的最佳测量方法。对于八种患者用药不依从行为达成了共识：未开初始处方和未服用第一剂（起始阶段）；延迟续方、漏服、服用过量、服用时间错误和不正确给药（执行阶段）；以及过早停药（维持阶段）。对于七种测量方法达成了共识：自我报告、处方配药数据、药丸计数、药物水平、电子药物监测（EDM）、智能技术和直接观察。自我报告问卷最常被评为“至少有些适合”用于测量行为。EDM 被评为测量漏服、服用过量和服用时间错误的最佳方法。处方配药数据被评为不填初始处方、延迟续方和停药的最佳方法。直接观察被评为测量不当给药的最佳方法。适合和最佳的测量方法因不依从行为而异。研究人员应选择最适合评估其研究目标行为的测量方法。
