Adherence measure Advantages Disadvantages Least Objective Non– judgemental  Easy to perform in clinic  Inaccurate questioning by clinician Cheap Over-estimates   adherence Self-report questionnaires Easy to perform in clinic Inaccurate   Cheap Recall inaccuracy   Susceptible to self-  desirability bias  Over-estimates adherence Daily diary cards Inaccurate   Reduces recall Susceptible to self-   inaccuracy desirability bias Amenable to Over-estimates   technological advances adherence Prescription– refill data Cheap Inaccurate   Reduces self– Over-estimates   desirability bias adherence Susceptible to dose  “dumping” No guarantee dispensed  medication is taken Canister weight/ dose Cheap Not time-sensitive   counters  Reduces self- desirability  Over-estimates bias adherence Susceptible to dose  “dumping” Drug assays  Objective  Impractical in clinical Accurate setting  Short term adherence  monitoring Electronic Monitoring Most Objective Expensive   Devices (EMDs) Accurate Device malfunctions   Continuous adherence Detect device actuation,  • monitoring not inhalation Most Objective
Adherence measure Advantages Disadvantages Least Objective Most Objective Non– judgemental questioning by clinician  Easy to perform in clinic  Cheap  Inaccurate  Over-estimates adherence Self-report questionnaires  Easy to perform in clinic  Cheap  Inaccurate  Recall inaccuracy  Susceptible to self- desirability bias  Over-estimates adherence Daily diary cards   Reduces recall inaccuracy  Amenable to technological advances  Inaccurate  Susceptible to self- desirability bias  Over-estimates adherence Prescription– refill data  Cheap  Reduces self– desirability bias  Inaccurate  Over-estimates adherence  Susceptible to dose “dumping”  No guarantee dispensed medication is taken Canister weight/ dose counters  Cheap  Reduces self- desirability bias  Not time-sensitive  Over-estimates adherence  Susceptible to dose “dumping” Drug assays  Objective  Accurate  Impractical in clinical setting  Short term adherence monitoring Electronic Monitoring Devices (EMDs)  Most Objective  Accurate  Continuous adherence monitoring  Expensive  Device malfunctions • Detect device actuation, not inhalation
Rob_Morton_Thesis_Submission_December_2017.docx