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

Background 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. Purpose To review the literature for self-report instruments and electronic monitors used to measure medication adherence in patients with chronic disease. Methods 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. Results 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 (R)). Validity was higher among electronic monitoring systems compared with self-report measures. Conclusion 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.