Pill counts, self reports, and electronic monitoring—Which is most informative in the study of therapy adherence in Parkinson's disease?
✍ Scribed by Katherine Grosset; Donald Grosset
- Book ID
- 102509547
- Publisher
- John Wiley and Sons
- Year
- 2007
- Tongue
- English
- Weight
- 31 KB
- Volume
- 22
- Category
- Article
- ISSN
- 0885-3185
No coin nor oath required. For personal study only.
✦ Synopsis
We read with interest the report by Elm et al. 1 They found that a self-report of therapy compliance (the Morisky medication adherence questionnaire) was more sensitive to nonadherence to anti-parkinson medication than pill count. We compared four methods of assessing therapy adherence in Parkinson's disease: self-report, visual analogue scale, pill count, and electronic monitoring. 2 We found that in patients who adhere well to the prescribed regimen (i.e., taking over 80% of total prescribed medication, as measured by the "gold standard" of electronic monitoring), there is good agreement between these four methods, but in those who take less than 80% of prescribed medication, self-report, visual analogue, and pill counts all significantly overestimate total adherence, when compared with electronic monitoring results. Accordingly, selfreports and pill counts may both be misleading.
Medication timing, as determined by electronic monitoring, fails to provide continuous dopaminergic stimulation due to irregular time intervals between doses. 2,3 High total therapy adherence rates in Parkinson's disease 1-3 might imply that adherence is less of an issue than in other disease areas. But this is incorrect, as erratic timing of medication intake is common. 2,3 Some hint of this issue comes from the Morisky selfreport data-56% of patients reported high adherence while 44% of patients reporting medium adherence. 1 We are currently co-coordinating a further study of antiparkinson therapy intake in five European centers, with a focus on timing adherence. Optimizing therapeutic coverage by improved medication timing could be a useful additional strategy in the clinical management of Parkinson disease.