Combining adherence monitoring with patient education in the Royal Perth Hospital Immunology Outpatient Clinic
Herrmann, S., McKinnon, E. and Mallal, S. (2004) Combining adherence monitoring with patient education in the Royal Perth Hospital Immunology Outpatient Clinic. In: 16th Annual Conference of the Australasian Society for HIV Medicine, 2 - 4 September, Canberra, Australia.
At Royal Perth Hospital we conceptualise a model of adherence support that considers the adaptive and dynamic nature of adherence behaviour in the current clinical context. Our 2002-2003 survey of adherence showed that 25% of patients reported never missing medication. We wished to feedback results of the survey to the patients and reinforce good adherence behaviours whilst continuing to monitor missed doses.
The monitoring ‘tool’, is an A4 sheet. On one side is information regarding issues related to HIV treatment, this changes ~3 monthly. On the other is a table that does not alter, which allows the patient to identify the number of doses they have missed in the last month. The physician asks the patient for an estimate of tablets missed. This allows for a discussion of how the patient is managing with their medication. The doctor records a percent score of medication taken in the last month. To determine the usefulness of this practice we correlated the scores with viral load, CD4 count, and mean cell volume (MCV).
Medication scores were obtained from 381 individuals (mean number per person = 2.5), over a one year period. A total of 180 patients (47%) achieved scores of 100% for all visits. Scores were highly correlated with viral load (p <0.0001) and, amongst those on at least 6 months of therapy, 76% of individuals with a score reflecting 100% adherence maintained plasma HIV RNA levels below 50 copies/ml. The proportion with undetectable viral load levels was reduced to 25% amongst those with average scores below 85%. Higher medication scores were associated with improved immunologic response as measured by the rate of increase in CD4 + T cell count (p = 0.003) and %CD4 + T cells (p = 0.03). To assess the correlation of these scores with an independent measure of adherence, values of MCV were obtained from those individuals on at least 6 months of AZT or d4T therapy. MCV was found to be consistently higher in those with higher scores (p = 0.01).
This simple monitoring tool appears to provide a useful measure of adherence that is associated with both virological and immunological response to therapy.
|Publication Type:||Conference Item|
|Murdoch Affiliation:||Centre for Clinical Immunology and Biomedical Statistics|
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