9990 · 3.2.2
Measuring non-adherence flashcards
Revision flashcards for Cambridge 9990 Measuring non-adherence (syllabus 3.2.2). Flip, recall, then mark a real past-paper question.
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Self-report adherence?
Patient questionnaire or interview — **cheap and easy** but vulnerable to **social desirability bias** (overreporting).
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Pill count method?
Compare pills dispensed vs pills remaining — more **objective** but patients may **dump pills** to appear adherent.
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Biochemical marker example?
Blood/urine test for drug metabolites — e.g. HbA1c for long-term glucose control in diabetes; **high validity** but invasive and costly.
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MEMS cap?
Electronic Medication Event Monitoring System — records bottle opening times; detects **timing** of doses but not whether pill was swallowed.
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Direct vs indirect measures?
Direct — observe ingestion or detect drug in body; indirect — pill count, pharmacy refill records, self-report.
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Ethical issue in adherence monitoring?
**Privacy** — covert monitoring undermines trust; patients must **consent** to biochemical testing and electronic tracking.
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What is the main limitation of using self-report measures (e.g., questionnaires) to assess adherence?
They are highly susceptible to bias, particularly social desirability bias (patients wanting to please the practitioner) and recall bias (inaccurate memory), often leading to an overestimation of adherence.
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Define 'pill dumping' in the context of measuring adherence.
This is when a patient deliberately discards medication before a pill count to create the false impression of being adherent. It is a key weakness of using pill counts as a measure.
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Why are biochemical tests considered a highly objective measure of adherence?
Because they directly detect the presence of a drug or its metabolites in a patient's bodily fluids (e.g., blood or urine), providing physical proof of recent ingestion.
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What is 'white-coat adherence'?
A phenomenon where a patient improves their adherence behaviour (e.g., takes their medication) just before a medical appointment. This can make them appear adherent on a biochemical test, masking their typical non-adherence.
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What is a major practical disadvantage of using biochemical markers to measure adherence?
They are expensive, invasive (require blood/urine samples), and require specialised laboratory analysis, making them impractical for routine, large-scale monitoring.