Open Access Highly Accessed Research article

Suitability of measures of self-reported medication adherence for routine clinical use: A systematic review

Sara Garfield1*, Sarah Clifford1, Lina Eliasson12, Nick Barber1 and Alan Willson3

Author Affiliations

1 The Centre for Medication Safety and Service Quality, The School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, UK

2 Centre for Haematology, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK

3 National Leadership and Innovation Agency for Healthcare, Bridgend Road, Llanharan, Glamorgan, UK

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BMC Medical Research Methodology 2011, 11:149  doi:10.1186/1471-2288-11-149

Published: 3 November 2011

Abstract

Background

There is a recognised need to build primary care medication adherence services which are tailored to patients' needs. Continuous quality improvement of such services requires a regular working method of measuring adherence in order to monitor effectiveness. Self report has been considered the method of choice for clinical use; it is cheap, relatively unobtrusive and able to distinguish between intentional and unintentional non-adherence, which have different underlying causes and therefore require different interventions. A self report adherence measure used in routine clinical practice would ideally be brief, acceptable to patients, valid, reliable, have the ability to distinguish between different types of non-adherence and be able to be completed by or in conjunction with carers where necessary.

Methods

We systematically reviewed the literature in order to identify self report adherence measures currently available which are suitable for primary care and evaluate the extent to which they met the criteria described above. We searched the databases Medline, Embase, International Pharmaceutical Abstracts, Pharmline, CINAHL, PsycINFO and HaPI to identify studies reporting the development, validation or reliability of generic adherence measures. One reviewer screened all abstracts and assessed all relevant full text articles obtained and a second reviewer screened/assessed 10% to check reliability.

Results

Fifty eight measures were identified. While validation data were presented in support of the vast majority of self reported measures (54/58), data for a relatively small number of measures was presented for reliability (16/58) and time to complete (3/58). Few were designed to have the ability to be completed by or in conjunction with carers and few were able to distinguish between different types of non-adherence, which limited their ability be used effectively in the continuous improvement of targeted adherence enhancing interventions. The data available suggested that patients find it easier to estimate general adherence than to report a specific number of doses missed. Visual analogue scales can be easier for patients than other types of scale but are not suitable for telephone administration.

Conclusions

There is a need for a measure which can be used in the routine continual quality monitoring of adherence services.