A multimethod approach including use of refill data may be the most effective method to identify nonadherence in young patients with chronic kidney disease.
Using pharmacy refill data, in addition to provider assessment, helps identify medication nonadherence better than the perceptions of health care providers alone, according to a new study published in Pediatric Nephrology.
Nonadherence to medication regimens can be detrimental to patient outcomes and lead to significant health care costs. In the specialty pharmacy setting, medication adherence is key to patients being treated for chronic and complex conditions.
In the study, the researchers examined medication nonadherence in a population of young patients with chronic kidney disease. Using 5 different measures of nonadherence, they tracked 87 adolescents and young adults aged 11 through 19 years with chronic kidney disease or end-stage renal disease. The measures of nonadherence were provider reports, patient reports and caregiver reports, electronic pill boxes, and pharmacy refill data.
Providers alone typically make assessments of a patient to identify nonadherence, but individual perceptions are not always accurate. However, technological advances offer additional opportunities to track a patient’s compliance to their treatment.
Based on the findings, health care providers and electronic pillboxes both identified 34.5% of patients as nonadherent, but disagreed about which patients were nonadherent. Additionally, patient reports, caregiver reports, and pharmacy refill data all classified between 50% and 60% of patients as nonadherent. The study showed that combining provider reports and pharmacy refill data provided the the most balanced sensitivity (0.90) and negative predictive power (.88).
The study demonstrates the benefits of using a multimethod approach to identify nonadherence in patients with chronic disease, an essential first step to improve compliance, the researchers concluded.
“In general, providers are already doing assessment of patients’ adherence levels, and most clinical practices have the ability to access pharmacy refill data, so this is a very feasible thing to start doing in a clinical setting,” study author Cozumel Pruette, MD, MHS, assistant professor of pediatrics at Johns Hopkins Children’s Center, said in a press release.
The researchers indicated that more research is needed to determine whether this multimethod approach is also the most effective way to measure adherence levels in other patient populations.
Pruette CS, Coburn SS, Eaton CK, et al. Does a multimodel approach improve identification of medication nonadherence in adolescents with chronic kidney disease? Pediatric Nephrology. 2018. https://link.springer.com/article/10.1007%2Fs00467-018-4044-x
Study: Technology and Doctors Combine to Detect Patients Who Don’t Take Their Pills [news release]. Johns Hopkins Medicine’s website. https://www.hopkinsmedicine.org/news/newsroom/news-releases/study-technology-and-doctors-combine-to-detect-patients-who-dont-take-their-pills. Accessed January 3, 2019