Journal Articles

The Correlation of Patient Reported versus Observed Medication Adherence in Type 2 Diabetes (T2DM)

November 08, 2014

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

  1. 2Duke Clinical Rsch Institute, Duke Univ, Durham, NC
  2. 3Duke Transational Medicine Institute, Duke Univ, Durham, NC
  3. 4Medicine – Endocrinology and Metabolism, Duke Univ Sch of Medicine, Durham, NC
  4. 5Duke Translational Medicine Institute, Duke Univ, Durham, NC
  5. 6Diabetes Management Clinic, Williamson Memorial Hosp, Williamson, WV
  6. 7Community Health, Cabarrus Health Alliance, Kannapolis, NC
  7. 8Sch of Health Related Professions, Univ of Mississippi Med Cntr, Jackson, MS
  8. 9Sch of Nursing, Duke Univ, Durham, NC

Abstract

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.

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