8-item Morisky Medication Adherence Scale Research Articles

Side effects and medication adherence of tyrosine kinase inhibitors for patients with chronic myeloid leukemia in Taiwan

Nonadherence is common in patients with chronic myeloid leukemia (CML) and leads to treatment failure and poor outcomes. Side effects due to treatment are also common in patients with CML. However, no study has investigated the link between side effects and medication adherence for patients with CML in Taiwan. Therefore, the aim of our study was to explore the influence of side effects on medication adherence in Taiwanese patients with CML.CML in chronic-phase patients treated with breakpoint cluster region-Abelson murine leukemia viral oncogene homolog 1 tyrosine kinase inhibitors were recruited. We designed a questionnaire to collect baseline patient information, medication adherence (measured using the 8-item Morisky Medication Adherence Scale), and side effects. Clinical outcomes were assessed by the 3-month early molecular response rate and the 12-month major molecular response rate. Statistical comparisons of different parameters between adherent and nonadherent groups were conducted.Fifty-eight patients were enrolled in this study, and 31% of them had poor adherence. The lack of information about treatment and medication was the major reason for poor medication adherence. Patients who were younger and unmarried were prone to poor adherence. The occurrence of side effects carried no statistically significant influence on adherence. Poor adherence resulted in a poor treatment response (lower 3-month early molecular response rate and lower 12-month major molecular response rate).Poor adherence is common in Taiwanese patients with CML. The main reason for a decrease in the adherence rate is the lack of comprehensive information about treatment and medication, particularly in young and single population. The next urgent step is to educate patients about their treatment and management of side effects to improve adherence and treatment outcome for patients with CML in Taiwan.

Cross-cultural adaptation and validation of a European Portuguese version of the 8-item Morisky medication adherence scale

Introduction and ObjectiveThe 8-Item Morisky Medication Adherence Scale (MMAS-8) is one of the most widely used instruments to assess medication adherence, but a validated European Portuguese version of MMAS-8 does not exist. Our aim was to develop and validate a European Portuguese version of the MMAS-8. MethodsA process of translation and back-translation of the original MMAS-8 was performed. The questionnaire was administered in nine community pharmacies and one public hospital between March 2014 and September 2015. Adult patients taking at least one antihypertensive drug were invited to participate. A confirmatory factor analysis was performed and internal consistency, convergent validity and concurrent validity were examined. ResultsA total of 472 patients were enrolled in the study. The mean MMAS-8 score obtained was 6.74±1.39. One hundred and thirty-two patients were classified as low adherers (28%), 181 (38.3%) as medium adherers and 159 (33.7%) as high adherers. For the factorial structure of the Portuguese version of the MMAS-8, the fit indices of the final model (chi-square [18] 48.465, p<0.001) are suggestive of very good fit, with comparative fit index 0.95, root mean square error of approximation 0.06 (90% confidence interval 0.04-0.08), and standardized root mean square residual 0.04, confirming that the construct tested was unidimensional. The Cronbach's alpha for all items was 0.60, and the translated version presents convergent validity and concurrent validity. ConclusionA European Portuguese version of the MMAS-8 was created that maintained a similar structure to the original MMAS-8 and good psychometric properties.

Cross-cultural adaptation and validation of a European Portuguese version of the 8-item Morisky medication adherence scale

The 8-Item Morisky Medication Adherence Scale (MMAS-8) is one of the most widely used instruments to assess medication adherence, but a validated European Portuguese version of MMAS-8 does not exist. Our aim was to develop and validate a European Portuguese version of the MMAS-8. A process of translation and back-translation of the original MMAS-8 was performed. The questionnaire was administered in nine community pharmacies and one public hospital between March 2014 and September 2015. Adult patients taking at least one antihypertensive drug were invited to participate. A confirmatory factor analysis was performed and internal consistency, convergent validity and concurrent validity were examined. A total of 472 patients were enrolled in the study. The mean MMAS-8 score obtained was 6.74±1.39. One hundred and thirty-two patients were classified as low adherers (28%), 181 (38.3%) as medium adherers and 159 (33.7%) as high adherers. For the factorial structure of the Portuguese version of the MMAS-8, the fit indices of the final model (chi-square [18] 48.465, p<0.001) are suggestive of very good fit, with comparative fit index 0.95, root mean square error of approximation 0.06 (90% confidence interval 0.04-0.08), and standardized root mean square residual 0.04, confirming that the construct tested was unidimensional. The Cronbach's alpha for all items was 0.60, and the translated version presents convergent validity and concurrent validity. A European Portuguese version of the MMAS-8 was created that maintained a similar structure to the original MMAS-8 and good psychometric properties. O questionário de adesão 8-Item Morisky Medication Adherence Scale (MMAS-8) é um dos instrumentos mais usados em nível mundial na avaliação da adesão à terapêutica. No entanto, não existe uma versão portuguesa devidamente validada. O nosso objetivo foi desenvolver e validar a versão portuguesa do MMAS-8. Após um processo de tradução e retrotradução do MMAS-8 original, a versão portuguesa foi administrada em nove farmácias comunitárias e um hospital público entre março de 2014 e setembro de 2015. Todos os doentes adultos a tomar pelo menos um anti-hipertensor foram convidados a participar no estudo. Foi feita uma análise fatorial confirmatória e foram avaliadas a consistência interna, a validade convergente e a validade concorrente. Foram incluídos 472 doentes. A pontuação média obtida no MMAS-8 foi 6,74±1,39. Foram classificados como tendo uma adesão baixa 132 (28%) doentes, 181 (38,3%) como tendo média adesão e 159 (33,7%) como tendo alta adesão. Na avaliação da estrutura fatorial da versão portuguesa do MMAS-8, os índices de ajuste do modelo final (chi-quadrado (18)=48,465, p < 0,001) são sugestivos de um ajuste muito bom, com CFI=0,95; RMSEA=0,06 [intervalo de confiança de 90%: 0,04; 0,08] e SRMR=0,04, e confirmaram que a construção testada é unidimensional. O alfa de Cronbach foi 0,60 e o MMAS-8 apresentou validade convergente e concorrente. Obtivemos uma versão em português do MMAS-8 que manteve uma estrutura semelhante à do MMAS-8 original e com boas propriedades psicométricas.

Adherence to COPD treatment in Turkey and Saudi Arabia: results of the ADCARE study.

BackgroundCOPD affects millions of people worldwide. Poor treatment adherence contributes to increased symptom severity, morbidity and mortality. This study was designed to investigate adherence to COPD treatment in Turkey and Saudi Arabia.MethodsAn observational, cross-sectional study in adult COPD patients in Turkey and Saudi Arabia. Through physician-led interviews, data were collected on sociodemographics and disease history, including the impact of COPD on health status using the COPD Assessment Test (CAT); quality of life, using the EuroQol Five-Dimension questionnaire (EQ-5D); and anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Treatment adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). Multivariate logistic regression analysis examined the predictors of non-adherence and the impact of adherence on symptom severity.ResultsFour hundred and five COPD patients participated: 199 in Turkey and 206 in Saudi Arabia. Overall, 49.2% reported low adherence (MMAS-8 <6). Of those, 74.7% reported high disease impact (CAT >15) compared to 58.4% reporting medium/high adherence (p=0.0008). Patients with low adherence reported a lower mean 3-level EQ-5D utility value (0.54±0.35) compared to those with medium/high adherence (0.64±0.30; p<0.0001). Depression with HADS score 8–10 or >10 was associated with lower adherence (OR 2.50 [95% CI: 1.43–4.39] and 2.43 [95% CI: 1.39–4.25], respectively; p=0.0008). Being a high school/college graduate was associated with better adherence compared with no high school (OR 0.57 [95% CI: 0.33–0.98] and 0.38 [95% CI: 0.15–1.00], respectively; p=0.0310). After adjusting for age, gender, and country, a significant association between treatment adherence (MMAS-8 score ≥6) and lower disease impact (CAT ≤15) was observed (OR 0.56 [95% CI: 0.33–0.95]; p=0.0314).ConclusionAdherence to COPD treatment is poor in Turkey and Saudi Arabia. Non-adherence to treatment is associated with higher disease impact and reduced quality of life. Depression, age, and level of education were independent determinants of adherence.

Association between meibomian gland dysfunction and compliance of topical prostaglandin analogs in patients with normal tension glaucoma.

PurposeThe aim of this study was to investigate the association between tear film and meibomian gland parameters in patients with normal tension glaucoma (NTG), who underwent topical prostaglandin analog (PGA) monotherapy, and medication compliance.MethodsOcular surface disease index (OSDI), Schirmer’s test, tear film break-up time (TBUT), keratoepitheliopathy (KEP) score with fluorescein, and meibomian gland parameters were assessed in 45 eyes of 45 patients with NTG (NTG group), who received topical PGA monotherapy for more than 1 year. The results were compared to those of 40 eyes of 40 normal subjects (control group). Medication compliance was assessed by an 8-item Morisky Medication Adherence Scale (MMAS-8). Multiple logistic regression analysis was used to identify the factors associated with medication compliance.ResultsThere was a significant difference in OSDI (P = 0.043), Schirmer’s test (P < 0.001), TBUT (P < 0.001), KEP score (P = 0.015) and all meibomian gland parameters (all P < 0.001) between two groups. When the NTG group was divided into compliant and non-compliant groups based on the scores of MMAS-8, 30 (75%) patients were classified into the compliant group. Multiple logistic regression analysis revealed that the lid margin score (OR, 0.256; 95% CI, 0.072–0.908, P = 0.035), meibum score (OR, 0.144; 95% CI, 0.023–0.915, P = 0.04), and meibo score (OR, 0.344; 95% CI, 0.140–0.845, P = 0.02) were significant factors associated with compliance in patients with NTG. The meibomian gland parameters showed a negative correlation with medication compliance (all P < 0.005).ConclusionsMalfunction of the meibomian glands can be an important clinical finding associated with compliance of PGA monotherapy in patients with NTG.

Abstract TP177: Previous Stroke/TIA History is Associated With Low Medication Adherence in a Multi-ethnic Cohort of Stroke Survivors

Introduction: Proper adherence to medication regimens including antihypertensive, antidiabetic, and lipid-lowering medications has been shown to reduce risk of stroke-related events. Yet stroke and TIA survivors have suboptimal levels of adherence. Few studies have investigated how medication adherence differs between patients with previous stroke/TIA history compared to patients admitted for a first stroke event. Methods: The present analysis examined baseline data from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study, an RCT of a skills-based educational intervention in a multi-ethnic cohort of stroke/TIA patients (n=458). The primary outcome measure was medication adherence, which was self-reported using the 8-item Morisky Medication Adherence Scale (MMAS-8). Medication adherence was calculated and categorized as low adherence (score&lt;6; 39%) and medium/high adherence (score 6-8; 61%). The exposure was previous stroke/TIA events, and was categorized as no previous stroke/TIA events (67%) and at least one previous stroke/TIA event (33%). Unadjusted and adjusted logistic regression models were used to investigate the relationship between previous stroke/TIA events and medication adherence. The multivariable model adjusted for relevant clinical and socio-demographic characteristics. Results: The unadjusted logistic regression model assessing the relationship between previous stroke/TIA and medication adherence was not significant (OR: 0.70 , p=0.08, 95% CI: 0.47-1.05). But, after adjusting for select clinical and socio-demographic characteristics the model showed that patients with a history of previous stroke/TIA events were significantly less likely to have medium/high medication adherence compared to patients admitted for a first stroke event (OR: 0.59 , p=0.02, 95% CI: 0.38-0.93). Conclusions: As part of continued preventive efforts, educational interventions such as DESERVE are necessary after a first stroke/TIA to improve medication adherence and reduce risk of future stroke/TIA events.

Real-world experience of women using extended-cycle vs monthly-cycle combined oral contraception in the United States: the National Health and Wellness Survey

BackgroundThe real-world experience of women receiving extended-cycle combined oral contraception (COC) versus monthly-cycle COC has not been reported.MethodsData were from the United States 2013 National Health and Wellness Survey. Eligible women (18–50 years old, premenopausal, without hysterectomy) currently using extended-cycle COC (3 months between periods) were compared with women using monthly-cycle COC. Treatment satisfaction (1 “extremely dissatisfied” to 7 “extremely satisfied”), adherence (8-item Morisky Medication Adherence Scale©), menstrual cycle-related symptoms, health-related quality of life (HRQOL) and health state utilities (Medical Outcomes Short Form Survey-36v2®), depression (9-item Patient Health Questionnaire), sleep difficulties, Work Productivity and Activity Impairment-General Health, and healthcare resource use were assessed using one-way analyses of variance, chi-square tests, and generalized linear models (adjusted for covariates).ResultsParticipants included 260 (6.7%) women using extended-cycle and 3616 (93.3%) using monthly-cycle COC. Women using extended-cycle COC reported significantly higher treatment satisfaction (P = 0.001) and adherence (P = 0.04) and reduced heavy menstrual bleeding (P = 0.029). A non-significant tendency toward reduced menstrual pain (39.5% versus 47.3%) and menstrual cycle-related symptoms (40.0% versus 48.7%) was found in women using extended-cycle versus monthly-cycle COC. Significantly more women using extended-cycle COC reported health-related diagnoses, indicating preferential prescription for extended-cycle COC among women reporting more health problems. Consistent with this poorer health, more women using extended-cycle COC reported fatigue, headache, and activity impairment (P values < 0.05). There were no other significant differences between groups.ConclusionsThis real-world observational study supports extended-cycle COC as a valuable treatment option with high satisfaction, high adherence, and reduced heavy menstrual bleeding.

Evaluating Factors Impacting Medication Adherence Among Rural, Urban, and Suburban Populations.

To evaluate differences in prescription medication adherence rates, as well as influencing factors, in rural and urban adults. This is a retrospective analysis of the 2015 National Consumer Survey on the Medication Experience and Pharmacists' Role. A total of 26,173 participants completed the survey and provided usable data. Participants using between 1 and 30 prescription medications and living more than 0 miles and up to 200 miles from their nearest pharmacy were selected for the study, resulting in a total of 15,933 participants. Data from the 2010 US Census and Rural Health Research Center were used to determine the population density of each participant's ZIP code. Participant adherence to reported chronic medications was measured based on the 8-item Morisky Medication Adherence Scale (MMAS-8). Overall adherence rates did not differ significantly between rural and urban adults with average adherence based on MMAS-8 scores of 5.58 and 5.64, respectively (P = .253). Age, income, education, male sex, and white race/ethnicity were associated with higher adherence rates. While the overall adherence rates between urban and rural adults were not significantly different, the factors that influenced adherence varied between age-specific population density groupings. These analyses suggest that there is no significant difference in adherence between rural and urban populations; however, the factors contributing to medication adherence may vary based on age and population density. Future adherence intervention methods should be designed with consideration for these individualized factors.

EFFECT OF MEDICATION RELATED EDUCATIONAL INTERVENTIONS ON IMPROVING MEDICATION ADHERENCE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Objectives: To assess the patient medication adherence using 8 item morisky medication adherence scale (MMAS). To categorize patients based on their adherence to antidiabetic medications into low, medium, and high adherent. To provide educational interventions such as patient counseling using teach-back method, patient medication information leaflet, and audio-visual aids and thus to improve the patient medication adherence.Methods: After obtaining informed consent from the patients, data of the patients were recorded in data collection forms. Their adherence to antidiabetic medication was evaluated using 8 item MMAS and patients were categorized into low, medium, and high adherence groups based on the score. Counseling was done based on the categorization (high, medium, and low). During review, again adherence was rechecked using 8 item MMAS.Results: Medication adherence was measured using 8 item MMAS on review and adherence was found to be improved using different patient counseling methods according to their adherence category. Improvement in score within low adherence group was found to be 83.87%; improvement of the low adherence group to medium adherence group was 16.12%. Improvement within the medium adherence group was 82.14% and from medium adherence to high adherence group was 17.85%.Conclusion: Patient counseling can improve adherence in type 2 diabetes mellitus patients, which in turn help patients in achieving optimal glycemic control.

EFFECT OF MEDICATION RELATED EDUCATIONAL INTERVENTIONS ON IMPROVING MEDICATION ADHERENCE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Objectives: To assess the patient medication adherence using 8 item morisky medication adherence scale (MMAS). To categorize patients based on their adherence to antidiabetic medications into low, medium, and high adherent. To provide educational interventions such as patient counseling using teach-back method, patient medication information leaflet, and audio-visual aids and thus to improve the patient medication adherence.Methods: After obtaining informed consent from the patients, data of the patients were recorded in data collection forms. Their adherence to antidiabetic medication was evaluated using 8 item MMAS and patients were categorized into low, medium, and high adherence groups based on the score. Counseling was done based on the categorization (high, medium, and low). During review, again adherence was rechecked using 8 item MMAS.Results: Medication adherence was measured using 8 item MMAS on review and adherence was found to be improved using different patient counseling methods according to their adherence category. Improvement in score within low adherence group was found to be 83.87%; improvement of the low adherence group to medium adherence group was 16.12%. Improvement within the medium adherence group was 82.14% and from medium adherence to high adherence group was 17.85%.Conclusion: Patient counseling can improve adherence in type 2 diabetes mellitus patients, which in turn help patients in achieving optimal glycemic control.

Does augmentation with antipsychotic agents affect the medication adherence of the child with obsessive-compulsive disorder?

Antipsychotic agents can be used for augmentation when the response to treatment is insufficient in children with obsessive compulsive disorder. Our aim was to investigate adherence to treatment between patients with and without antipsychotic augmentation and factors potentially related to this. One hundred fourteen children and adolescents aged 8-18 years diagnosed with OCD and still receiving treatment were included in the study. Fifty-two subjects were received antipsychotic therapy for augmentation, while 62 were not receiving it. All subjects were evaluated using a sociodemographic data form, the 8-item Morisky Medication Adherence Scale (MMAS-8), and the Udvalg for Klinikse Undersegelser (UKU) side-effects rating scale. The results were then subjected to statistical analysis. Total MMAS-8 scores were statistically significantly lower in the augmentation group than in the monotherapy group (p: 0.01). Sex, receipt of psychotherapy and family monitoring of treatment had no effect on total MMAS-8 scores (p: 0.949, p: 0.394, and p: 0.198, respectively). Higher UKU side-effect rating scale scores were determined in the augmentation group compared to the monotherapy group (p

Knowledge and information levels and adherence to oral anticoagulant therapy with warfarin in patients attending primary health care services.

Background Oral anticoagulation therapy with warfarin is widely used around the world and its safety and efficacy are well-established. Nevertheless, anticoagulants are among the drug classes most associated with fatal medication errors in primary health care. Objective To investigate patient knowledge, the level of information provided, and medication adherence in patients treated with warfarin at a primary health care service. Method A cross-sectional study of a prospective cohort of 60 patients on warfarin treatment in the town of Ijuí, Rio Grande do Sul, Brazil. A questionnaire was administered to test patients’ knowledge about their prescriptions and the level of information provided by the health team. The 8-item Morisky Medication Adherence Scale (MMAS-8) and International Normalized Ratio (INR) were used to verify adherence to treatment. Results The results were expressed in absolute and relative values and prevalence ratios were calculated, with respective 95% confidence intervals. It was found that 83.3% of the participants had been given insufficient information by the health team, 50% did not know how to use the medication correctly, 86.7% were not adherent to the treatment according to MMAS-8 and 63.3% were outside of the correct INR range. Conclusion In this study, we observed a need to improve the quality of information provided to users and to develop strategies to improve adherence to treatment, to ensure the safety of patients treated with warfarin in primary health care services.

Influence of Major Coping Strategies on Treatment Non-adherence and Severity of Comorbid Conditions in Hemodialysis Patients.

BackgroundNon-adherence and comorbidities are prevalent among hemodialysis patients and are associated with increased mortality and financial burden. We aimed to investigate the influence of major coping strategies (CSs) on non-adherence and comorbidities in hemodialysis patients.MethodsA total of 49 patients were enrolled. We collected participant data including CS measured by a Korean version of the ways of coping questionnaire (K-WCQ), comorbidities measured by age-adjusted Charlson comorbidity index (CCI), and adherence measured by the 8-item Morisky medication adherence scale (MMAS-8).ResultsRegarding major CS, 61.2% of participants reported use of support-seeking CS (SUP group), 14.3% reported use of problem-focused CS (PRO group), and 24.5% reported use of hopeful-thinking CS (HOP group). The mean MMAS-8 score was higher in the PRO group than in the HOP group (P = 0.024). The mean CCI score was lower in the PRO group than in the HOP group (P = 0.017). In the HOP group, the severity of somatic symptoms was positively correlated with the scores for the emotion-focused CS subscale (r = 0.39, P = 0.029) and the hopeful-thinking CS subscale (r = 0.38, P = 0.036) of the K-WCQ. The level of life satisfaction positively correlated with the score for the problem-focused CS subscale in the HOP group (r = 0.40, P = 0.027).ConclusionWe should pay more attention to the CSs of hemodialysis patients and provide interventions that promote problem-focused CSs, especially for nonadherent patients with high comorbidity rates who mainly use a hopeful-thinking CS.

Association between medication adherence and blood pressure control in urban hypertensive patients in central India

Introduction: Cardiovascular and renal complications associated with hypertension (HTN) can be reduced if blood pressure (BP) is well controlled. However, a large percentage of patients fail to achieve target BPs, largely due to poor medication adherence. We conducted a cross-sectional study of patients of HTN to assess patient adherence to treatment and the association between medication adherence and BP control.Methodology: The study was a cross-sectional survey of adult hypertensive patients of either sex who had been on antihypertensive therapy for the past 3 months. Medication adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). Level of control of BP was evaluated using the BP goals recommended by the Eighth Joint National Committee (JNC-8).Results: Out of a total of 200 patients, only 29.5% of patients had achieved their target BP as per JNC-8 recommendations after a minimum of 3 months of antihypertensive therapy. The average adherence score on the MMAS-8 was 6.47 (±1.8). A high adherence was found in 39% of patients, while 32.5% of HTN patients had a medium score and 28.5% had low adherence scores. There was a significant correlation between medication adherence and BP control. Only 1.5% of patients with low adherence score and 11.5% with medium score had achieved their target BP while 16.5% with high had done so.Conclusion: Higher medication adherence scores were associated with better BP control. However, the percentage of patients with controlled HTN on treatment was low as was the proportion of patients with a high medication adherence score.

The Atrial Fibrillation Health Literacy Information Technology System: Pilot Assessment.

BackgroundAtrial fibrillation (AF) is a highly prevalent heart rhythm condition that has significant associated morbidity and requires chronic treatment. Mobile health (mHealth) technologies have the potential to enhance multiple aspects of AF care, including education, monitoring of symptoms, and encouraging and tracking medication adherence. We have previously implemented and tested relational agents to improve outcomes in chronic disease and sought to develop a smartphone-based relational agent for improving patient-centered outcomes in AF.ObjectiveThe objective of this study was to pilot a smartphone-based relational agent as preparation for a randomized clinical trial, the Atrial Fibrillation Health Literacy Information Technology Trial (AF-LITT).MethodsWe developed the relational agent for use by a smartphone consistent with our prior approaches. We programmed the relational agent as a computer-animated agent to simulate a face-to-face conversation and to serve as a health counselor or coach specific to AF. Relational agent’s dialogue content, informed by a review of literature, focused on patient-centered domains and qualitative interviews with patients with AF, encompassed AF education, common symptoms, adherence challenges, and patient activation. We established that the content was accessible to individuals with limited health or computer literacy. Relational agent content coordinated with use of the smartphone AliveCor Kardia heart rate and rhythm monitor. Participants (N=31) were recruited as a convenience cohort from ambulatory clinical sites and instructed to use the relational agent and Kardia for 30 days. We collected demographic, social, and clinical characteristics and conducted baseline and 30-day assessments of health-related quality of life (HRQoL) with the Atrial Fibrillation Effect on Quality of life (AFEQT) measure; self-reported medication adherence with the Morisky 8-item Medication Adherence Scale (MMAS-8); and patient activation with the Patient Activation Measure (PAM).ResultsParticipants (mean age 68 [SD 11]; 39% [12/31] women) used the relational agent for an average 17.8 (SD 10.0) days. The mean number of independent log-ins was 19.6 (SD 10.7), with a median of 20 times over 30 days. The mean number of Kardia uses was 26.5 (SD 5.9), and participants using Kardia were in AF for 14.3 (SD 11.0) days. AFEQT scores improved significantly from 64.5 (SD 22.9) at baseline to 76.3 (SD 19.4) units at 30 days (P<.01). We observed marginal but statistically significant improvement in self-reported medication adherence (baseline: 7.3 [SD 0.9], 30 days: 7.7 [SD 0.5]; P=.01). Assessments of acceptability identified that most of the participants found the relational agent useful, informative, and trustworthy.ConclusionsWe piloted a 30-day smartphone-based intervention that combined a relational agent with dedicated content for AF alongside Kardia heart rate and rhythm monitoring. Pilot participants had favorable improvements in HRQoL and self-reported medication adherence, as well as positive responses to the intervention. These data will guide a larger, enhanced randomized trial implementing the smartphone relational agent and the Kardia monitor system.

The Mediating Role of Adherence on the Relationship between Health Locus of Control and Quality of Life in Adults with Asthma

Objective - It was previously assumed that the relationship between HLOC and quality of life may be mediated by adherence. HLOC plays a role in determining a person's behavior, including adherence to medical regimens. Methodology/Technique - HLOC was measured by the Multidimensional Health Locus of Control Scale, adherence was measured by the 8-item Morisky Medication Adherence Scale (MMAS-8), and quality of life was measured by the Quality of Life Scale. Findings - The results indicate that Internal HLOC (β = 0,497, p&lt;0.005) and Powerful Others HLOC (β = 0,264, p&lt;0.005) significantly predict quality of life, respectively. However, adherence does not mediate the relationship between HLOC and quality of life (p=ns) Novelty - The study concludes that adherence is not a mediator between HLOC and QOL. Type of Paper - Empirical Keywords: Asthma; Adherence; Chronic Illness; Health Locus of Control, Quality of Life. JEL Classification: I10, I19.

Criterion validity of 8-item Morisky Medication Adherence Scale in patients with asthma.

The 8-item Morisky Medication Adherence Scale (MMAS-8) is reliable and valid in patients with hypertension, but to our knowledge validity has not been established for patients with asthma. The aim of the study was to determine the criterion validity of the MMAS-8 in patients with asthma. In the cross-sectional study patients older than 12 year were recruited when dispensed asthma medications in community pharmacies. Criterion validity of the scale was assessed through associations with asthma control and quality of life. Asthma control was assessed by the Asthma Control Test (ACT) and quality of life was evaluated by the Saint George Respiratory Questionnaire (SGRQ). A total of 208 patients (mean age 56 years, 59% female) were included in the study. Almost all patients were prescribed inhaled corticosteroids (96%). Asthma was not controlled in 37% of the patients and 22% experienced at least one exacerbation requiring emergency room visit, hospitalization or treatment with oral corticosteroid therapy in the previous year. The 8-item MMAS was significantly associated with asthma control and quality of life. Patients who scored 8 points, <8 to >6 points and ≤6 points on the scale were considered to have high, medium and low adherence, respectively. High, medium and low adherence was found in 53%, 23% and 24% of the patients, respectively. As adherence improved from low to medium or from medium to high, the odds of asthma control increased by 1.7 times (OR 1.65, p = 0.027). Patients with high and medium adherence had SGRQ scores that were 6.1 and 5.3 points lower, respectively, compared with patients with low adherence. The MMAS-8 was found to be valid for assessing medication adherence and predicting health outcomes in patients with asthma.

Adherence to inhaled therapies of COPD patients from seven Latin American countries: The LASSYC study.

BackgroundThis study assessed the adherence profiles to inhaled therapies and the agreement between two patient self-report adherence methods in stable COPD lpatients from seven Latin American countries.MethodsThis observational, cross-sectional, multinational, multicenter study involved 795 COPD patients (post-bronchodilator forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC] <0.70). Adherence to inhaled therapy was assessed using the specific Test of Adherence to Inhalers (10-item TAI) and the generic 8-item Morisky Medication Adherence Scale (MMAS-8) questionnaires. The percentage agreement and the kappa index were used to compare findings.Results59.6% of patients were male (69.5±8.7 years); post-bronchodilator FEV1 percent predicted was 50.0±18.6%. Mean values for 10-item TAI and MMAS-8 questionnaires were 47.4±4.9 and 6.8±1.6, respectively. Based on the TAI questionnaire, 54.1% of patients had good, 26.5% intermediate, and 19.4% poor adherence. Using the MMAS-8 questionnaire, 51% had high, 29.1% medium, and 19.9% low adherence. According to both questionnaires, patients with poor adherence had lower smoking history, schooling but higher COPD Assessment Test score, exacerbations in the past-year and post-bronchodilator FEV1. The agreement between 10-item TAI and MMAS-8 questionnaires was moderate (Kappa index: 0.42; agreement: 64.7%).ConclusionSuboptimal adherence to medication was frequent in COPD patients from Latin America. Low adherence was associated with worse health status impairment and more exacerbations. There was inadequate agreement between the two questionnaires. Greater effort should be made to improve COPD patients’ adherence to treatment, and assessment of adherence with more specific instruments, such as the TAI questionnaire, would be more convenient in these patients.Clinical Trial RegistrationNCT02789540

The association of psychosocial variables with adherence to antiepileptic drugs in patients with temporal lobe epilepsy

ObjectiveThe aim of this study was to explore the association between psychosocial factors and adherence to antiepileptic drugs (AEDs) in patients with temporal lobe epilepsy (TLE). MethodsThis cross-sectional study was conducted with 123 individuals with TLE, admitted to our epilepsy center from December 2015 to May 2017. The participants completed standardized self-report questionnaires measuring medication adherence, anxiety, depression, and family and social support. Adherence was measured by the 8-item Morisky Medication Adherence Scale (MMAS), and logistic regression was used to examine statistically significant associations of different variables with adherence. ResultsWe found a 33.3% rate of poor AED adherence. Moderate-to-severe anxiety (odds ratio (OR)=2.851, 95% confidence interval (CI)=1.138–7.144, P=0.025) and the presence of hippocampal sclerosis (OR=3.098, 95% CI=1.259–7.620, P=0.014) were positively associated with poor adherence to antiepileptic drugs. Social support (OR=0.925, 95% CI=0.863–0.990, P=0.025) was negatively associated with poor adherence. Neither depression nor family support was associated with adherence. ConclusionOne-third of patients with TLE were prone to poor AED adherence, especially individuals with hippocampal sclerosis. Intervention approaches designed to improve AED adherence in patients with TLE should focus on psychosocial factors.

Safety of once- or twice-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with nonvalvular atrial fibrillation: A NOAC-TR study.

Once-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) may increase patient adherence to treatment but may also be associated with a higher risk of bleeding. In this study, we investigated the adherence to once- or twice-daily dosing of NOACs and the risk of bleeding in nonvalvular atrial fibrillation (NVAF) patients. This multicenter cross-sectional study, conducted between 1 September 2015 and 28 February 2016, included 2214 patients receiving NOACs for at least 3 months, due to NVAF. Patients receiving once-daily or twice-daily NOAC doses were 1:1 propensity score matched for baseline demographic characteristics and the presence of other diseases. The medication adherence was assessed by the 8-item Morisky Medication Adherence Scale. Risk factors were investigated in relation to minor and major bleeding. The mean age of patients was 71 ± 10 years, and 53% of the patients were women. The medication adherence was lower in patients receiving twice-daily NOAC doses compared to once-daily-dose group (47% versus 53%, p = 0.001), and there was no difference between the groups in terms of minor (15% versus 16%, p = 0.292) and major bleeding (3% versus 3%, p = 0.796). Independent risk factors for bleeding were non-adherence to medication (OR: 1.62, 95% CI: 1.23-2.14, p = 0.001), presence of 3 or more other diseases (OR: 10.3, 95% CI: 5.3-20.3, p < 0.001), and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol) score (OR: 4.84, 95% CI: 4.04-5.8, p < 0.001). In summary, the once-daily dose of NOACs was associated with increased patient adherence to medication, while it was not associated with bleeding complications.