The agreement between self-reported medication adherence and directly observed counts of pills and insulin pens was only “fair” among a cohort of patients with type 2 diabetes at high risk for complications, recent study findings show. Kelly K, et al . BMJ Open Diabetes Res Care. 2016;doi:10.1136/bmjdrc-2015-000182.

From www.endodcrinetoday.com

Nyhetsinfo www red DiabetologNytt

Intervention consisted of a home visit, including a physician assessment, review of medications and completion of patient-reported outcome surveys for medication adherence and other health behaviors. At each visit, nurse practitioners administered the Morisky Medication Adherence Scale (MMAS), and also determined medication adherence using pill counts, medication bottle dates and direct observation of insulin administration. Nurse practitioners then assigned medication adherences scores to patients that ranged from 0% to 20%, 20% to 80% or at least 80%, reflecting the proportion of medication taken. A score of at least 80% was considered adherent.

Researchers found that about half of the cohort was categorized as adherent; however, self-reported adherence (n = 261; 61%) was lower than directly observed adherence (n = 338; 79%). Agreement between the two reporting measures was considered “fair” (kappa statistic = 0.24; 95% CI, 0.15-0.33).

For both adherence measures, researchers found that higher adherence was associated with lower HbA1c (P < .001), but the ability of each measure to discriminate between lower and higher blood glucose was weak.

Researchers noted several possible reasons for the discrepancies. Patients taking multiple medications with various dosing instructions may have difficulty recognizing their level of adherence or the MMAS may lack sensitivity, making it a “poor indicator” of actual medication use.

“In SEDI, factors that classified patients as high risk included recent hospitalizations, substance use, tobacco use and multiple comorbidities — including coronary artery disease, hypertension, heart failure or chronic kidney disease — all of which require complex medication regimens,” the researchers wrote. “As a result, patients may report that they are ‘getting enough medications’ daily, skewing self-reported results and suggesting that improvement in diagnostic measures is needed, particularly in illnesses with multiple comorbidities.

Regardless of the underlying reasons for lack of agreement between self-report and observed counts, every effort must be made to discover where, in this high-risk population, the breakdown occurs,” the researchers wrote. 

Disclosure: The researchers report no relevant financial disclosures.