Language-concordant ATSM assessed self-reported adherence as well as a structured interview when validated against pharmacy-claims CMG
Source
Ratanawongsa (2018). Language-concordant automated telephone queries to assess medication adherence in a diverse population: a cross-sectional analysis of convergent validity with pharmacy claims. BMC Health Services Research.
Description #
Among 210 diverse, low-income diabetes patients, language-concordant automated telephone self-management (ATSM) queries assessed self-reported medication adherence as well as — if not better than — a computer-assisted structured interview, when both were validated against an objective pharmacy-claims measure (continuous medication gap, CMG). This supports ATSM as a scalable, asynchronous adherence-assessment method for linguistically diverse populations.
"ATSM assessment of self-reported adherence performed as well as, if not better than, interview by a research analyst." (Ratanawongsa, 2018, p. 5)
"Language-concordant ATSM demonstrated modest potential for assessing adherence." (Ratanawongsa, 2018, p. 1)
Methods Context #
What? #ⓘ
The observable: convergent validity of self-reported adherence — prevalence of optimal adherence (continuous medication gap, CMG ≤ 20%, from pharmacy claims over 12 months) across categories of self-reported missed pill-days (0, 1, 2–7).
"Continuous medication gap (CMG) is an objective measure of adherence that uses pharmacy dispensings to measure gaps in patients' available supply of medications." (Ratanawongsa, 2018, p. 2)
How? #ⓘ
Cross-sectional convergent-validity analysis: self-reported adherence collected two ways — via the language-concordant ATSM system (A-0001ArtifactA-0001Initial AI draftLanguage-concordant automated telephone self-management (ATSM, SMARTSteps)To assess patient-reported medication adherence and deliver self-management support to a linguistically diverse, low-income population with diabetes — in each patient's own language — outside of usual clinic visits. Depl…) and via computer-assisted structured interview — then compared against claims-based CMG using Fisher's exact tests across missed-day categories.
"To evaluate the convergent validity of each patient-reported adherence assessment method for each therapeutic indication, we used Fisher's exact tests to compare the prevalence of optimal adherence (CMG ≤ 20%) vs. suboptimal adherence (CMG > 20%) across the 3 categories of participant responses." (Ratanawongsa, 2018, p. 4)
Who? #ⓘ
210 San Francisco Health Plan members with diabetes (mean age 56; 75% women; 64% Asian/Pacific Islander, 20% Latino), 46% with limited health literacy, 57% Cantonese-speaking and 19% Spanish-speaking; a low-income, multilingual safety-net population.
"Among 210 participants, 46% had limited health literacy, 57% spoke Cantonese, and 19% Spanish." (Ratanawongsa, 2018, p. 1)
Other Notes #
ATSM was embedded in a larger self-management/health-coaching intervention, not used solely for adherence assessment.
Caveats #
- Short 7-day self-report recall against a 1-year claims window plus selection bias limit the ATSM validity estimates The self-report recall window (7 days) differed from the claims-based CMG capture period (1 year), which can attenuate convergent validity (and may explain the non-significant diabetes-pill gradient). CMG was not calculable for some participants, the statistical comparison is conservative, prescribing data could bias CMG, and the sample is subject to selection bias with limited generalizability; the study was underpowered for subgroup analyses.