Patient Concordance among Type 2 Diabetics - Dissertation Example

Download file to see previous pages Compliance can be assessed through direct and indirect methods. The latter is commonly conducted using self-reports and interviews. However, when the validity of the self-reported scale of medication-taking behaviour in predicting blood pressure levels, it was found that most participants had mid-range scores. As a result, the sensitivity of these self-report methods was 0. 81, and the specificity was marked at 0.44. Thus, not all non-compliant patients can be detected. Conversely, not all who were detected to be non-compliant have problems with medication adherence. Pill counts are another indirect way of determining patient compliance. However, this may be circumvented by throwing away pills. Another measurement of compliance is the achievement of treatment goals. Despite its logically sound basis, patients who are partially compliant may still have a successful outcome (Chaterjee 2005). Researchers still do not agree as to the most accurate indirect method in assessing compliance (Karve et al. 2008)

Medication possession ratio (MPR) is one of the more used indirect measures of adherence. Using the pharmacy administrative data of date and number of pills given to participants, MPR can be calculated by getting the ratio of the sum of the day's medication is supplied over a fixed time interval. Summary of Diabetes Self-Care Activities (SDSCA) is a questionnaire regarding the different aspects of patient adherence. One of its scales determines how many days in the past week diabetes pills were taken as prescribed, while some of its questions were regarding diet and exercise. A simpler, four-item Morisky Self-Reported Medication-Taking Scale has also been developed, with a score of equal to or less than two indicating poor compliance. In an RCT comparing these three measures, strongly significant correlations among baseline MPR, Morisky score and SDSCA medication-taking items were found. In turn, the lowest MPR was also significantly associated with the highest HbA1c and the subset that takes multiple oral anti-diabetes medications. In contrast, self-reports were not significantly associated with the direct measure used (Cohen 2010).

Direct methods, or measurement of drug concentrations in the blood, are less used in determining patient compliance despite their high sensitivity and specificity because they are more expensive, invasive, and difficult to perform. For example, direct observation at the time of taking medicine or changing wound dressings is impractical measure of determining compliance (Chatterjee 2005). However, it has its limitations as individuals vary in absorption, metabolism and excretion of drugs. In addition, measuring concentration levels cannot evaluate the secondary non-compliance of patients. Moreover, these measurements do not provide significant insight into the causes for non-adherence, leading clinicians to blame patients for not following treatment regimens (Bell et al. 2007). ...Download file to see next pages Read More