Baltimore, MD—If pharmacists and other healthcare providers could better identify patients likely to be nonadherent to their prescription medications, they might be more effective in combating the problem.

That’s the assumption behind a study published online by Pediatric Nephrology. It looked at the predictive value of combining technology with the perceptions of healthcare providers.

Johns Hopkins University School of Medicine researchers conducted the study in a population of young adults and adolescents with chronic kidney disease (CKD) but suggested the results have broader application.

“We want to have better ways to figure out who is nonadherent so we can focus our efforts better on those patients who may require more assistance or specific resources to improve adherence,” explained first author Cozumel Pruette, MD, MHS, assistant professor of pediatrics at Johns Hopkins Children’s Center. “There are resources we can provide to boost adherence if we know who needs them.”

Background information in the report notes that between $68 billion and $150 billion of avoidable healthcare costs in the United States have been blamed on nonadherence, which is defined as any deviation from agreed-upon recommendations from a healthcare provider.

Even more concerning than the costs, according to study authors, is that poor adherence among youth with CKD is one of the main causes of progression to end-stage renal disease.

For the study, Pruette and her coauthors used five different measures of nonadherence in a population of 87 adolescents and young adults, ages 11 through 19 years, with CKD or end-stage renal disease. Participants came from one of 17 participating medical providers at one of three academic medical centers.

Measures of adherence were:
• Provider reports
• Patient reports and caregiver reports based on eight-question surveys
• Electronic pill boxes that record the date and time of every pill bottle opening
• Pharmacy refill data

Results indicate that healthcare providers and electronic pillboxes both classified 34.5% of patients as nonadherent, although they disagreed about which patients fell into that category.

At the same time, patient reports, caregiver reports, and pharmacy-refill data all classified between half and 61% of patients as nonadherent. Researchers combined provider reports and pharmacy-refill data to obtain the most balanced sensitivity (0.90) and negative predictive power (.88).

“In general, providers are already doing assessments of patients’ adherence levels, and most clinical practices have the ability to access pharmacy refill data, so this is a very feasible thing to start doing in a clinical setting,” Pruette suggested.

Noting that nonadherence is prevalent in adolescents and young adults with CKD, study authors conclude, “Providers inaccurately identify nonadherence, leading to missed opportunities to intervene. Our study demonstrates the benefit to utilizing a multimethod approach to identify nonadherence in patients with chronic disease, an essential first step to reduce non-adherence.”

Pruette added, “We can't say what other specific populations our findings apply to, but it’s likely generalizable that some kind of multi-modal approach is really the most meaningful in identifying nonadherence and providing us with the greatest level of information to help patients improve their adherence.”

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