METHODS OF MEASURING MEDICATION USE/COMPLIANCE IN THE COMMUNITY DWELLING POPULATION OF OLDER PEOPLE
Pill counts measure compliance by comparing the number of doses remaining in a container with the number of doses that should remain, if the patient’s compliance were perfect. This method can provide an overestimation of compliance if the patient is aware that a pill count is going to be conducted—patients may remove excess doses and discard them. Another drawback to this method is that it cannot verify that a dose removed from a container was actually consumed, or whether it was consumed at the correct time. Pill counts are not suitable for medications taken on an as-needed basis. Pill counts can provide an accurate measure of compliance under the following circumstances: when they are conducted in a patient’s home; when the patient is not aware that a pill count is going to be conducted; when there are reliable records to confirm the amount of medication dispensed, the date the most recent prescription refill was begun, how much medication was left over from the previous prescription when the current prescription was begun, and whether there was any change in the prescription; and a determination can be made regarding whether the patient stores medication in other locations or has shared any of the medications with friends or family.
Kogos (2004) utilized the pill-count method to determine adherence to all medications taken by a group of 30 men age 69 to 86 who were receiving treatment at a Veteran’s Administration Medical Center. Study subjects were described by their healthcare professional as nonadherent. The purpose of the study was to determine whether attendance at five support-group sessions would increase adherence. The proportion of prescribed doses taken was calculated for each medication using the following formula: number of pills dispensed minus number of pills present in the bottle/number of pills expected to be taken according to the prescription instructions. Following the initial pill count, these treatment group members brought all their prescribed medications to each of the five group meetings. The support groups for the treatment condition included the use of contracts, enlisting social support, monitoring and giving feedback, and education about healthy lifestyles. Control group members completed only an initial and final pill count; they attended five support-group sessions where issues other than treatment adherence were discussed. Treatment group members demonstrated a significant improvement in their pharmacological adherence, as measured by pre- to post-pill count; however, there was no significant difference between members of the treatment group and control group on pill count. The failure to find a difference may have been attributed to the low number of support meetings, as most research indicates a minimum of eight meetings is necessary for a treatment effect to show. In addition, pre-treatment compliance was high compared to other studies—77.3 percent for the treatment group and 87.6 percent for the control group, despite the referral criteria for inclusion in the study. The researchers conclude that there is preliminary support for a multicomponent adherence group to increase medication compliance.