Accurate Assessment of Adherence Self-Report and Clinician Report vs Electronic Monitoring of Nebulizers

被引:164
作者
Daniels, Tracey [1 ]
Goodacre, Lynne [2 ]
Sutton, Chris [2 ]
Pollard, Kim [3 ]
Conway, Steven [3 ]
Peckham, Daniel [3 ]
机构
[1] York Teaching Hosp Fdn NHS Trust, York Hosp, York Adult Cyst Fibrosis Unit, Ward 34, York YO31 8HE, N Yorkshire, England
[2] Univ Cent Lancashire, Sch Publ Hlth & Clin Sci, Preston PR1 2HE, Lancs, England
[3] Leeds Teaching Hosp NHS Trust, St Jamess Hosp, Leeds Reg Adult Cyst Fibrosis Unit, Leeds, W Yorkshire, England
关键词
CYSTIC-FIBROSIS; DEVICE COMPLIANCE; ADULTS; NONADHERENCE; CHILDREN;
D O I
10.1378/chest.09-3074
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: People with cystic fibrosis have a high treatment burden. While uncertainty remains about individual patient level of adherence to medication, treatment regimens are difficult to tailor, and interventions are difficult to evaluate. Self-and clinician-reported measures are routinely used despite criticism that they overestimate adherence. This study assessed agreement between rates of adherence to prescribed nebulizer treatments when measured by self-report, clinician report, and electronic monitoring suitable for long-term use. Methods: Seventy-eight adults with cystic fibrosis were questioned about their adherence to prescribed nebulizer treatments over the previous 3 months. Self-report was compared with clinician report and stored adherence data downloaded from the I-Neb nebulizer system. Adherence measures were expressed as a percentage of the prescribed regimen, bias was estimated by the paired difference in mean (95% CI) patient and clinician reported and actual adherence. Agreement between adherence measures was calculated using intraclass correlation coefficients (95% CI), and disagreements for individuals were displayed using Bland-Altman plots. Results: Patient-identified prescriptions matched. the medical record prescription. Median self-reported adherence was 80% (interquartile range, 60%-95%), whereas median adherence measured by nebulizer download was 36% (interquartile range, 5%-84.5%). Nine participants overmedicated and underreported adherence. Median clinician report ranged from 50% to 60%, depending on profession. Extensive discrepancies between self-report and clinician report compared with nebulizer download were identified for individuals. Conclusions: Self-and clinician-reporting of adherence does not provide accurate measurement of adherence when compared with electronic monitoring. Using inaccurate measures has implications for treatment burden, clinician prescribing practices, cost, and accuracy of trial data. CHEST 2011; 140(2):425-432
引用
收藏
页码:425 / 432
页数:8
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