Oſten, compliance is also used and the two can be used interchangeably in research and clinical practice . It describes “the extent to which the patients’ behavior (including medication-taking) coincides with medical or healthcare advice”, yet its meaning has become more negative regarding patient’s behaviors, since it implies patient’s passivity.
Nevertheless,measurement of medication adherence can be quite challenging since and parameters of acceptable adherence need to be carefully delineated and appropriated for individual situations. There are numerous tools available for these measurements, but these need to prove to be valid, reliable, and sensitive to change. The selection of a method to monitor adherence should be based on individual attributes and goals/resources of the study or the clinical setting. Currently none of the available methods can be considered as a gold standard and the combination of methods is recommended.
Objective measures include pill counts, electronic monitoring, secondary database analysis and biochemical measures and are thought to represent an improvement over subjective measures. As such, objective measures should be used to validate and correlate the subjective ones. However, a meta-analysis on adherence outcomes states that a multi-subjective-measure approach may have higher sensitivity, but not accuracy, over employing a single objective measure. In summary, subjective and objective measures have both advantages and disadvantages and should be used in combination.
The Medication Events Monitoring System (MEMS) is the most commonly used EMP device in medication adherence studies.
Studies show that approxi- mately 25% of all prescribed doses are omitted by patients.
This was in 1999 more recent studies say 50% are non adherent. like the study below:
Who. Defining adherence. Who. 2003;:1–28. www.who.int/chp/knowledge/publications/adherence_report/en/?
No single intervention is totally effective for all patients and it is not yet possible to predict which individual or subgroup actually needs a given intervention.
Patients also are reluctant to admit non-adherence unless clinicians make specific efforts to monitor the degree of adherence on a regular basis.
Studies have demonstrated that MEMS is more accurate than other available methods and is therefore considered the ‘‘gold standard’’ of adherence measurement. Despite these advantages, this tool has not yet been applied widely due to its cost and other practical issues that limit its use in large studies and routine clinical practice.[Top]
Patient satisfaction and value Patient satisfaction improved through enabling better self-care. The introduction of a system which enabled patients to view their test results, manage their medication list, and have secure messaging with their practice, resulted in 80% of responders (n = 448/560) saying the system facilitated their participation in their own care.
Another post-intervention survey found that 77–87% of 5391 patients across three sites who had online access to visit notes felt more in control of their care.
Of the clinician responses, 73 out of 104 (70%) felt that enabling patients to read their own notes online strengthened relationships, enhanced trust, and improved decision making.
Personal health records have been defined as:
- an electronic application through which individuals can access, manage and share their health information in a secure and confidential environment
- a tool for collecting, tracking and sharing important, up-to- date information about an individual’s health or the health of someone in their care
While there is no universal agreement in these definitions, they contain broadly similar themes: focusing on data repositories that can be used to securely store and manage personal medical information. These data repositories can be further classified into three distinct sub- categories
based around their integration and communication with provider systems:
- stand-alone: solely patient-recorded and maintained
- tethered: a read-only link to an electronic medical record
- integrated: asynchronous communications to/ from an electronic medical record.
Although the EHR and PHR have different end?user groups, they contain similar information. Ideally, they should be inter-operable. In the past few years, adoption of EHRs has been encouraged, whereas PHRs have not received the same level of attention. However, as Tang and Lansky and Ball et al discussed, the EHR alone may lack the ability to sufficiently motivate and engage patients to take a more active role in managing their own health, a condition found critical for improving care quality and efficiency . Therefore, PHRs have been recognized as a means of patient engagement. An EHR -coupled PHR, which is often referred as a patient?accessible EHR or tethered PHR , has been increasingly offered in the United States to patients as an institution?specific (limited to a certain organization) Internet portal by some large health care organizations (eg, Kaiser Permanente, Veterans Health Administration, Group Health Cooperative, CareGroup Health Care System, and Palo Alto Medical Foundation).
Due to the high incidence and prevalence of chronic conditions that generally require frequent monitoring and interventions, elderly people would benefit more because the PHR system could enable more coordinated and cost?effective communication and health care delivery.
The digital divide is defined as the gap that exists between individuals, groups, or communities in terms of the availability of ICT and the ability to use these technologies effectively.
Ten health conditions were found in the included studies. Seven of these ten health conditions had at least one study reporting benefit from the use of a PHR: asthma, diabetes, fertility, glaucoma, HIV, hyperlipidemia, and hypertension. Diabetes was the most studied condition with eleven of twelve studies showing benefit. Three conditions had studies that meth the criteria but did not show benefit of the PHR: cancer, idiopathic thrombocytopenic purpura (ITP), and multiple sclerosis.
70% of studies (16/23) reported benefits associated with PHR use.
However, there is no evidence that any study of the above provided evidence of better medication adherence or at least persistence.
Self-Manage Care – Using the PHR to make day-to- day decisions about care management, such as medication dosing, food choice.
This is the only grounds that medication intake was improved.
These conditions include: diabetes, hypertension, asthma, HIV, fertility management, glaucoma, and hyperlipidemia. Benefits were seen in care quality, access, and/or productivity. These conditions share several common characteristics: Each of these conditions is chronic. They have a significant benefit from self-management through behavioral changes. Many have an aspect of monitoring, either from the clinician or the patient (self-monitoring). Self-management is present in all. The seven conditions were conditions where the self-management behaviors could be suitably tracked in a PHR and were tightly linked to the feedback of monitoring/self-monitoring of indicators (Figure 3). For ex- ample, self-monitoring blood pressure in hypertension or glucose levels in diabetes allowed for more specific and direct feedback to patients using a PHR.