The Correlation of Patient Reported versus Observed Medication Adherence in Type 2 Diabetes (T2DM) American Heart Association 2014, Katherine Kelly1; Maria Grau-Sepulveda2; Leoncio Flavio Rojas3; Bryan C Batch4; Melodie Staton5; Anne Wolfley2; Vicki Hatfield6; Monica Murphy7; Ellen Jones8; Bradi Granger
- 2Duke Clinical Rsch Institute, Duke Univ, Durham, NC
- 3Duke Transational Medicine Institute, Duke Univ, Durham, NC
- 4Medicine – Endocrinology and Metabolism, Duke Univ Sch of Medicine, Durham, NC
- 5Duke Translational Medicine Institute, Duke Univ, Durham, NC
- 6Diabetes Management Clinic, Williamson Memorial Hosp, Williamson, WV
- 7Community Health, Cabarrus Health Alliance, Kannapolis, NC
- 8Sch of Health Related Professions, Univ of Mississippi Med Cntr, Jackson, MS
- 9Sch of Nursing, Duke Univ, Durham, NC
Introduction: Medication adherence in T2DM improves glycemic control (A1c) and is associated with reduced adverse clinical events. Self-reported medication adherence is a more feasible but less objective measure of actual adherence. Our aim was to determine the correlation between self-reported Morisky Medication Adherence Scale (MMAS) and direct observation of medication use by nurse practitioners (NP) during a home visit.
Methods: In a cohort of high-risk patients (n=299) with T2DM in 4 counties participating in the Southeastern Diabetes Initiative (SEDI), we conducted a prospective intervention involving NP home visits. Baseline adherence was measured using self-reported MMAS and direct observation of pills, vials and pens. Adherence measures were dichotomized to “adherent” or “not adherent” using established cut-points. Interrater agreement was evaluated using Cohen’s Kappa.
Results: In this cohort, the mean age was 58.6 (11.8), a majority were black (n=158, 52.8%), male (n=161, 53.8%), living with a partner (n=217, 76.4%) and insured by Medicare and/or Medicaid (n=248, 82.9%). Thirteen percent (n=30) had low health literacy (< 3rd grade). Interrater agreement between the two adherence measures was fair (kappa=0.28; CI 0.17-0.40; p<.0001)
Conclusions: Self reported medication adherence in high-risk patients with T2DM may be a poor indicator of actual medication use. Home visits may be needed in high-risk patients to more accurately assess medication use and decrease risks associated with medication dosing and administration errors.