title: Measuring therapy adherence in Parkinson's disease: a comparison of methods.
abstract: The objective of this study was to assess different methods of measuring therapy adherence in Parkinson's disease (PD). In a single centre observational study, 112 patients with idiopathic PD were randomised to a crossover trial of active monitoring (n = 69, simple tablet count and electronic monitoring), or to no monitoring (n = 43, control group). All patients completed a self report and visual analogue scale (VAS) indicating therapy intake. In the active monitoring group, 56 (81% of cases) used > or = 80% of their medication, and 13 (19% of cases) used <80%, based on electronic monitoring. Median adherence for self report was 100% (interquartile range (IQR) 100 to 100) and for VAS was 100% (IQR 95 to 100), in both active and control groups. Patients taking > or = 80% of prescribed medication had a median total adherence of 98% (IQR 93 to 101) by electronic monitoring, which was similar to that from other
  
  
  METHODS
  self report 100%, IQR 100 to 100; VAS 100%, IQR 95 to 100; simple tablet count 98%, IQR 89 to 100. Median total adherence in patients taking <80% of medication was significantly lower by electronic monitoring (69%, IQR 44 to 74) than by other methods: self report 100%, IQR 100 to 100; VAS 100%, IQR 95 to 100; and simple tablet count 90%, IQR 78 to 100 (all p<0.0001). Sensitivities of self report (10%), VAS (17%), and simple tablet count (50%) were all low for detecting suboptimal medicine intake. Self report, VAS, and simple tablet counts are insensitive as predictors of suboptimal medicine usage in PD. How patients take their medicines influences interpretation of the therapy response and consequent management decisions, with implications for clinical trial analysis and clinical practice.
authors.affiliation: Institute of Neurological Sciences, Department of Neurology, Southern General Hospital, Glasgow G51 4TF. d.grosset@clinmed.gla.ac.uk
authors.forename: K A
authors.initials: KA
authors.lastname: Grosset
authors.forename: I
authors.initials: I
authors.lastname: Bone
authors.forename: J L
authors.initials: JL
authors.lastname: Reid
authors.forename: D
authors.initials: D
authors.lastname: Grosset
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018592:Cross-Over Studies; D003625:Data Collection; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008432:Mathematical Computing; D008609:Mental Status Schedule; D008838:Microcomputers; D008875:Middle Aged; D009460:Neurologic Examination / Q000187:drug effects; D010300:Parkinson Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D010349:Patient Compliance; D011446:Prospective Studies; D012650:Self Disclosure; D012680:Sensitivity and Specificity; D016037:Single-Blind Method
chemical_list: D000978:Antiparkinson Agents