title: Concordance of Direct and Indirect Measures of Medication Adherence in A Treatment Trial for Cannabis Dependence.
abstract: The current study compared adherence rates as measured by two indirect measurement methods (pill count and daily medication diary) to two direct measurement methods (urine riboflavin and serum 6-OH-buspirone level measurement) among participants (n = 109) in a medication treatment trial for cannabis dependence. Pill count and diary data showed high levels of percent agreement and strong kappa coefficients throughout the study. Riboflavin levels indicated lower level of percent in adherence during the study as compared to both pill count and self-report. In the subset of participants with 6-OH-buspirone levels (n = 58), the kappa coefficient also showed low to moderate agreement between the pill count and medication diaries with 6-OH-buspirone levels. In contrast to pill count and medication diaries, adherence as measured by riboflavin and 6-OH-buspirone significantly decreased over time. The findings from this study support previous work demonstrating that pill count and patient self-report of medication taking likely overestimate rates of medication adherence, and may become less reliable as the duration of a clinical trial increases.
authors.affiliation: Department of Psychiatry, Medical University of South Carolina, Charleston, SC 29425. Electronic address: mcraeal@musc.edu.
authors.forename: Aimee L
authors.initials: AL
authors.lastname: McRae-Clark
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425.
authors.forename: Nathaniel L
authors.initials: NL
authors.lastname: Baker
authors.affiliation: Department of Psychiatry, Medical University of South Carolina, Charleston, SC 29425.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Sonne
authors.affiliation: Department of Psychiatry, Medical University of South Carolina, Charleston, SC 29425.
authors.forename: C Lindsay
authors.initials: CL
authors.lastname: DeVane
authors.affiliation: Department of Psychiatry, Medical University of South Carolina, Charleston, SC 29425.
authors.forename: Amanda
authors.initials: A
authors.lastname: Wagner
authors.affiliation: Department of Psychiatry, Medical University of South Carolina, Charleston, SC 29425.
authors.forename: Jessica
authors.initials: J
authors.lastname: Norton
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002065:Buspirone / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D012256:Riboflavin / Q000652:urine*; D057566:Self Report; D017366:Serotonin Receptor Agonists / Q000097:blood*; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D015415:Biomarkers; D017366:Serotonin Receptor Agonists; D002065:Buspirone; D012256:Riboflavin
keywords: Adherence; Biological marker; Drug level monitoring; Medication diary; Self-report