1. Does a multimethod approach improve identification of medication nonadherence in adolescents with chronic kidney disease?
- Author
-
Pruette, Cozumel S., Coburn, Shayna S., Eaton, Cyd K., Brady, Tammy M., Tuchman, Shamir, Mendley, Susan, Fivush, Barbara A., Eakin, Michelle N., and Riekert, Kristin A.
- Subjects
- *
CLINICAL drug trials , *ANTIHYPERTENSIVE agents , *CAREGIVERS , *CHRONIC kidney failure , *HOSPITAL pharmacies , *MEDICAL personnel , *MEDICAL prescriptions , *PATIENT compliance , *STATISTICS , *DISEASE prevalence , *DIAGNOSIS - Abstract
Background: Medical provider assessment of nonadherence is known to be inaccurate. Researchers have suggested using a multimethod assessment approach; however, no study has demonstrated how to integrate different measures to improve accuracy. This study aimed to determine if using additional measures improves the accurate identification of nonadherence beyond provider assessment alone.Methods: Eighty-seven adolescents and young adults (AYAs), age 11-19 years, with chronic kidney disease (CKD) [stage 1-5/end-stage renal disease (ESRD)] and prescribed antihypertensive medication, their caregivers, and 17 medical providers participated in the multisite study. Five adherence measures were obtained: provider report, AYA report, caregiver report, electronic medication monitoring (MEMS), and pharmacy refill data [medication possession ratio (MPR)]. Concordance was calculated using kappa statistic. Sensitivity, specificity, positive predictive power, and negative predictive power were calculated using MEMS as the criterion for measuring adherence.Results: There was poor to fair concordance (kappas = 0.12-0.54), with 35-61% of AYAs classified as nonadherent depending on the measure. While both providers and MEMS classified 35% of the AYAs as nonadherent, sensitivity (0.57) and specificity (0.77) demonstrated poor agreement between the two measures on identifying which AYAs were nonadherent. Combining provider report of nonadherence and MPR < 75% resulted in the highest sensitivity for identifying nonadherence (0.90) and negative predictive power (0.88).Conclusions: Nonadherence is prevalent in AYAs with CKD. Providers inaccurately identify nonadherence, leading to missed opportunities to intervene. Our study demonstrates the benefit to utilizing a multimethod approach to identify nonadherence in patients with chronic disease, an essential first step to reduce nonadherence. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF