Physician assessment
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Questions asked during clinic visit
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Indication of non-adherence
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Easy to gather information
Quick
Inexpensive
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Subjective
Not standardised
Risk of recall bias
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Self-reported questionnaire
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Medication Adherence Report Scale for asthma
(MARS-A)10,
Morisky Medical Adherence Scale (MMAS) 11,Test of
Adherence to inhalers (TAI)12
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Pre-established cut-off point determines whether patient is adherent or
non-adherent
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Easy to use
Inexpensive
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Subjective
Risk of recall and reporting bias leading to overestimation of adherence
Usually only available in English
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Prescription Database
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Medication Possession Ratio (MPR), Proportion of Days Covered
(PDC)
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Percentage calculated
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Objective
Easy to use
Inexpensive
Adherence can be measured over a long time interval
Non-adherent patients can be easily identified
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Evidence of dispensed medication does not equate to medication
administered
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Dose Counter
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Dose counter on inhaler
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Comparison of expected to actual dose counter reading
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Quick
Easy to use
Inexpensive
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Not on all devices have a dose counter
‘Dose dumping’ will conceal non-adherence
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T2 Biomarker
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FeNO Suppression Test
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Change in FeNO
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Objective
Identifies non-adherence when used with DOT
Identifies patients with ICS-resistant T2 inflammation who may benefit
from biologic therapy
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Cost
Time and resource dependent for patient and HCP
Not widely used
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Serum drug level
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Serum ICS concentration
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Serum concentration
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Objective
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Invasive
Cost
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Electronic Monitoring Devices
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INCA, Propeller, Hailie, Turbu+
Respiro, Herotracker, CapMedic, Digihaler
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Frequency of inhaler use
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Objective
Some can distinguish between intentional and non-intentional (e.g. error
in inhaler technique) non-adherence
Patterns of non-adherence can be identified
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Usually requires the patient to own a smartphone device and be
technologically literate
Cost
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