title: The INCATM(Inhaler Compliance AssessmentTM): A comparison with established measures of adherence.
abstract: OBJECTIVE
  To compare the Inhaler Compliance AssessmentTM(INCATM), a novel audio-recording device objectively measuring timing and proficiency of inhaler use, against established adherence measures, and explore its discriminant and predictive validity.
  
  
  METHODS
  Prospective observational study; 184 chronic obstructive pulmonary disease (COPD) patients used an INCATM-enabled salmeterol/fluticasone inhaler for one-month post-hospital discharge.
  
  
  METHODS
  INCATM(Attempted, Attempted Interval, Actual) adherence correlated with Doses Used Rate, self-reported adherence and prescription refill for concurrent validity. Discriminant validity for reason for admission, cognition and lung function; predictive validity for health status and quality-of-life.
  
  
  RESULTS
  Rates of Attempted, Attempted Interval and Actual adherence were 59, 47 and 23%, respectively. Only 7% of participants had Actual adherence >80%. INCATMvariables significantly correlated with Doses Used Rate but not with self-report; Attempted and Attempted Interval were weakly associated with prescription refill. Higher cognitive and lung functioning groups had better INCATMadherence. Attempted and Attempted Interval predicted health status, while Doses Used Rate predicted quality-of-life.
  
  
  CONCLUSIONS
  INCATMdid not strongly correlate with self-report or prescription refill data. Discriminant and predictive validity demonstrated by INCATMsuggests the potential utility of the INCATMas a method to identify intentional and unintentional adherence to inhaled medication and facilitate targeted intervention.
authors.affiliation: a Department of Psychology, Division of Population Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland.
authors.forename: Catherine
authors.initials: C
authors.lastname: Moran
authors.affiliation: a Department of Psychology, Division of Population Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland.
authors.forename: Frank
authors.initials: F
authors.lastname: Doyle
authors.affiliation: b Department of Respiratory Medicine , Royal College of Surgeons in Ireland , Dublin , Ireland.|c Clinical Research Centre , Royal College of Surgeons in Ireland , Dublin , Ireland.
authors.forename: Imran
authors.initials: I
authors.lastname: Sulaiman
authors.affiliation: d Division of Population Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.affiliation: a Department of Psychology, Division of Population Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland.
authors.forename: Garrett
authors.initials: G
authors.lastname: Greene
authors.affiliation: e School of Psychology , National University of Ireland Galway , Galway , Ireland.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Molloy
authors.affiliation: f Trinity Centre for Bioengineering, Trinity College , The University of Dublin , Dublin , Ireland.|g School of Engineering, Trinity College , The University of Dublin , Dublin , Ireland.|h School of Medicine, Trinity College , The University of Dublin , Dublin , Ireland.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Reilly
authors.affiliation: b Department of Respiratory Medicine , Royal College of Surgeons in Ireland , Dublin , Ireland.|c Clinical Research Centre , Royal College of Surgeons in Ireland , Dublin , Ireland.
authors.forename: Richard W
authors.identifier: http://orcid.org/0000-0003-1179-6692
authors.initials: RW
authors.lastname: Costello
authors.affiliation: a Department of Psychology, Division of Population Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland.
authors.forename: Lisa
authors.initials: L
authors.lastname: Mellon
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
chemical_list: D001993:Bronchodilator Agents
keywords: adherence; chronic obstructive pulmonary disease (COPD); construct validity; electronic monitor; inhaler; predictive validity