Concordance Among Three Self-Reported Measures of Medication Adherence and Pharmacy Refill Records

Cook, Constance E.; Wade, William E.; Martin, Bradley C.; Perri, Matthew

doi:10.1331/1544345053623573

Cited by 77 publications

(61 citation statements)

References 12 publications

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“…Other diabetes-related factors such as adverse medication effects and complexity of regimen as well as systemrelated factors such as costs and access are known determinants of medication adherence (21,49) that may supersede selfe f fi c a c y a m o n g t h i s p o p u l a t i o n . Alternatively, investigators have noted that self-report may not accurately measure medication adherence (50), which may have affected our results. Because medication adherence has been shown to be associated with glycemic control (51,52), more detailed studies should address barriers to medication adherence across diverse populations.…”

Section: Discussionmentioning

confidence: 99%

Is Self-Efficacy Associated With Diabetes Self-Management Across Race/Ethnicity and Health Literacy?

2006

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OBJECTIVE -Although prior research demonstrated that improving diabetes self-efficacy can improve self-management behavior, little is known about the applicability of this research across race/ethnicity and health literacy levels. We examined the relationship between diabetes self-efficacy and self-management behavior in an urban, diverse, low-income population with a high prevalence of limited health literacy. RESEARCH DESIGN AND METHODS -We administered an oral questionnaire inSpanish and English to patients with type 2 diabetes at two primary care clinics at a public hospital. We measured self-efficacy, health literacy, and self-management behaviors using established instruments. We performed multivariate regressions to explore the associations between self-efficacy and self-management, adjusting for clinical and demographic factors. We tested for interactions between self-efficacy, race/ethnicity, and health literacy on selfmanagement.RESULTS -The study participants were ethnically diverse (18% Asian/Pacific Islander, 25% African American, 42% Latino/a, and 15% white), and 52% had limited health literacy (short version of the Test of Functional Health Literacy in Adults score Ͻ23). Diabetes self-efficacy was associated with four of the five self-management domains (P Ͻ 0.01). After adjustment, with each 10% increase in self-efficacy score, patients were more likely to report optimal diet (0.14 day more per week), exercise (0.09 day more per week), self-monitoring of blood glucose (odds ratio 1.16), and foot care (1.22), but not medication adherence (1.10, P ϭ 0.40). The associations between self-efficacy and self-management were consistent across race/ethnicity and health literacy levels. CONCLUSIONS -Self-efficacy was associated with self-management behaviors in this vulnerable population, across both race/ethnicity and health literacy levels. However, the magnitude of the associations suggests that, among diverse populations, further study of the determinants of and barriers to self-management is warranted. Policy efforts should be focused on expanding the reach of self-management interventions to include ethnically diverse populations across the spectrum of health literacy. Diabetes Care 29:823-829, 2006T ype 2 diabetes is one of the most common diseases in the U.S., affecting Ͼ16 million individuals (1). Diabetes disproportionately affects lowincome and racial/ethnic minorities (2), and there is an urgent need to improve quality of care and lower rates of avoidable complications for these populations (3). Patients with diabetes are expected to perform daily self-management activities to help avoid diabetes-related morbidity and mortality. Self-management is a cornerstone of diabetes care, and it is believed that improving patient self-efficacy is a critical pathway to improved selfmanagement.The concept of self-efficacy is based on social cognitive theory, which describes the interaction between behavioral, personal, and environmental factors in health and chronic disease. The theory of self-efficacy pro...

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Section: Discussionmentioning

confidence: 99%

Is Self-Efficacy Associated With Diabetes Self-Management Across Race/Ethnicity and Health Literacy?

2006

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“…However, self-report measures can be biased by inaccurate patient recall or by social desirability, whereby patients report an overly optimistic estimation of adherence to their healthcare providers. Pill counts are easy to perform, have been correlated with electronic medication monitors, and are frequently used in randomized, controlled clinical trials to assess medication adherence, [11][12][13] Although simple to measure, pill counts do not accurately capture the exact timing of medication taking, and the data can be manipulated by patients (eg, pill dumping). Each of these methods has advantages and disadvantages, and the use of a specific method to measure adherence will depend on the clinical scenario and availability of the data.…”

Section: Methodology Of Assessing Medication Adherencementioning

confidence: 99%

Medication Adherence

2009

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Abstract-Medication adherence usually refers to whether patients take their medications as prescribed (eg, twice daily), as well as whether they continue to take a prescribed medication. Medication nonadherence is a growing concern to clinicians, healthcare systems, and other stakeholders (eg, payers) because of mounting evidence that it is prevalent and associated with adverse outcomes and higher costs of care. To date, measurement of patient medication adherence and use of interventions to improve adherence are rare in routine clinical practice. The goals of the present report are to address (1) different methods of measuring adherence, (2) the prevalence of medication nonadherence, (3) the association between nonadherence and outcomes, (4) the reasons for nonadherence, and finally, (5)

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“…These concerns are appropriate, as the agreement between selfreported and claims-or refill-based measures of adherence is mixed, with most studies reporting a weak correlation. [24][25][26][27][28][29][30][31][32][33][34][35] Yet, whether these measures are similar in impacting outcomes is unknown and is an issue that should be of concern to payer and provider collaborative efforts to manage a population of patients with diabetes.…”

Section: Self-reported Adherencementioning

confidence: 99%

Impact of Adherence and Weight Loss on Glycemic Control in Patients with Type 2 Diabetes: Cohort Analyses of Integrated Medical Record, Pharmacy Claims, and Patient-Reported Data

McAdam‐Marx¹,

Bellows²,

Unni³

et al. 2014

JMCP

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BACKGROUND: Managed care organizations put great effort into managing the population of patients with type 2 diabetes mellitus (T2DM) because of the health and economic burden of this disease. In patients with T2DM, weight loss and glycemic control are primary treatment aims to help improve patient outcomes, but these goals are not easily achieved. While achieving these aims requires a multifaceted approach of drug therapy management and lifestyle modification, truly understanding the role of medication adherence in achieving these outcomes is important for both patient and population management. This study expands on existing evidence that weight loss is associated with improved glycemic control by examining the role of medication adherence in achieving these goals in a managed care setting. This study is unique in that these associations are evaluated using multiple sources of data, including medical records for treatment outcomes, pharmacy claims, and patient-reported data to assess medication adherence. These data sources represent those typically available to payers or providers.OBJECTIVE: To describe the relationships between medication and adherence, weight change, and glycemic control in patients with T2DM.METHODS: This historical cohort study included adult patients with T2DM in a large integrated health system and was based on electronic health record and pharmacy claims data from November 1, 2010, through October 31, 2011, as well as data from a self-reported adherence survey conducted in March 2012. Included patients received a diabetes medication from a therapeutic class not previously received, between November 1, 2010, and April 30, 2011 (index date), who had blood glucose (HbA1c) and weight values at index date and 6 months follow-up, participated in an adherence survey, and had ≥ 1 prescription claim for the index-date drug. Associations between the dual outcomes of weight loss (≥ 3%) and HbA1c control (< 7.0%), while controlling for medication adherence and other demographic, treatment, and clinical variables, were evaluated using structural equation models (SEM). Separate models adjusted for different measures of medication adherence-self-reported using the 5-item Medication Adherence Rating Scale (MARS-5) and a modified medication possession ratio (mMPR) from pharmacy claims data. RESULTS:The study included 166 patients with a mean age of 61.1 (standard deviation = 12.1) years; 56.0% were female. Medication adherence was high, with 72.2% adherent using MARS-5 and 77.1% using mMPR measures. The SEMs found that only self-reported medication adherence is associated with weight loss (MARS-5: OR = 1.70, 95% CI = 1.11-2.60), while both self-reported and claims-based medication adherence were associated with HbA1c < 7.0% (MARS-5: OR = 1.59, 95% CI = 1.09-2.34; mMPR: OR 2.71, 95% CI = 1.22-5.98). Further, weight loss is significantly associated with HbA1c < 7.0% (MARS-5: OR = 3.60, 95% CI = 2.39-5.46; mMPR: OR 2.99, 95% CI = 1.45-6.17).CONCLUSIONS: This study has provided additional evidence ...

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Concordance Among Three Self-Reported Measures of Medication Adherence and Pharmacy Refill Records

Cited by 77 publications

References 12 publications

Is Self-Efficacy Associated With Diabetes Self-Management Across Race/Ethnicity and Health Literacy?

Is Self-Efficacy Associated With Diabetes Self-Management Across Race/Ethnicity and Health Literacy?

Medication Adherence

Impact of Adherence and Weight Loss on Glycemic Control in Patients with Type 2 Diabetes: Cohort Analyses of Integrated Medical Record, Pharmacy Claims, and Patient-Reported Data

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