Assessing adherence to dermatology treatments: a review of self-report and electronic measures

Nonadherence to prescribed medications is a common problem in dermatology, and assessing adherence can be difficult. Electronic monitors are not always practical, but self-report measures may be less reliable.To review the literature for self-report instruments and electronic monitors used to measure medication adherence in patients with chronic disease.A PubMed literature search was conducted using the terms ‘scale,’‘measure,’‘self-report,’‘electronic,’ and ‘medication adherence.’ Relevant articles were reviewed and selected if they addressed self-report or electronic measures of adherence in chronic disease.Eleven self-report instruments for the measurement of adherence were identified. Four were validated using electronic monitors. All produced an estimate of adherence that correlated with actual behavior, although this correlation was not strong for any of the measures. None of the scales was tested in patients who had dermatologic disease and/or used topical medications. Several electronic monitoring systems were identified, including pill counts, pharmacy refill logs, and the Medication Event Monitoring System (MEMS ® ). Validity was higher among electronic monitoring systems compared with self-report measures.While several self-report measures of adherence have been validated in chronic disease populations, their relevance in dermatology patients has not been studied. A dermatology-specific instrument for the measurement of adherence would contribute to improved outcomes; until such a tool exists, researchers and clinicians should consider nonadherence as a possible factor in skin disease that is not responsive to treatment. Electronic monitoring provides the most reliable means of measuring adherence, and may provide additional clues to identify barriers to adherence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79087/1/j.1600-0846.2010.00431.x.pd

Health behaviour models: a framework for studying adherence in children with atopic dermatitis

Atopic dermatitis (AD) is a common problem of childhood causing considerable distress. Effective topical treatments exist, yet poor adherence often results in poor outcomes. A framework is needed to better understand adherence behaviour. To provide a basis for this framework, we reviewed established models used to describe health behaviour. Structural elements of these models informed the development of an adherence model for AD that can be used to complement empirical AD treatment trials. Health behaviour models provide a means to describe factors that affect adherence and that can mediate the effects of different adherence interventions. Models of adherence behaviour are important for promoting better treatment outcomes for children with AD and their families. These models provide a means to identify new targets to improve adherence and a guide for refining adherence interventions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79208/1/j.1365-2230.2009.03741.x.pd