Poor adherence in asthma patients has been associated with more wheezing and more frequent need for hospitalisations. Patients with the most severe asthma appear to have worse adherence than other asthma patients. The study by Sherman et al. (2000) was conducted to investigate whether telephoning the patient's pharmacy to obtain a prescription refill history gathers accurate information about medication-taking behaviour.

Mark scheme

Marking points from the official mark scheme (May/June 2020). The mark or mark type is shown in brackets.

1. [1] (a) They were identified before clinics by chart review.
2. [1] At the beginning of the clinic visit, a research nurse briefly interviewed the patient, caretaker, or both to find out the name and location of each pharmacy from which they obtained prescription medication.
3. [2] (b) Strength: Being identified by chart review meant that they were appropriate people to include. / Being interviewed meant that the nurse could explain the purpose of the study and the participant could give consent.
4. [2] Weakness: Opportunity sampling meant that the nurse could choose those who were more likely to adhere to taking medication. / Being interviewed by the nurse may mean that the participant felt obliged to take part.
5. [2] (c)(i) subjective: asking practitioner (Riekart and Droter, 1999) / objective: pill counting (Chung and Naya, 2000) / biochemical tests (Roth and Caron, 1978)
6. [2] (c)(ii) subjective: asking practitioner: practitioner knows the patient and their medical history: history of adhering or not / objective: pill counting: gives quantitative data so comparisons can be made / biochemical tests: if medicine has been taken then the test will reveal it with 100% accuracy
7. [1] (d) Advantages: Pharmacy records involve no subjective comment (which may be dishonest answers) from a patient. / Pharmacy records are objective measures: if the prescription is collected or not. / Pharmacy records provide quantitative data which can be statistically analysed and compared.
8. [1] Disadvantages: a patient should be allowed to comment on their own medication and why they may not be taking it. / the objective measure may not be valid: the pharmacy records only records the medication leaving the pharmacy (for example). / pharmacy records give numbers; they do not give explanations. / pharmacy records may not be reliable (recording of prescription, reporting of prescription over telephone).
9. [1] Conclusion: any appropriate conclusion drawn from the discussion that has been presented. A conclusion is a 'decision reached by reasoning' and so a summary of points already made scores 0 marks.