Self-reported Measure Of Medication Adherence Research Articles

Type D personality predicts poor medication adherence in myocardial infarction patients

Type D personality, the combination of negative affectivity (NA) and social inhibition (SI), is an emerging risk factor in cardiovascular disease. This study aimed to examine one possible behavioural mechanism to explain the link between Type D and ill-health. It was hypothesised that Type D personality would predict medication adherence in myocardial infarction (MI) patients. In a prospective study, 192 MI patients (54 females and 138 males) completed measures of Type D personality and provided demographic and medical information 1 week post-MI, and then 131 patients went on to complete a self-report measure of medication adherence 3 months post-MI. It was found that Type D personality predicts adherence to medication, after controlling for demographic and clinical risk factors. Critically, the constituent components of Type D, NA and SI, interact to predict medication adherence, after controlling for the effects of each component separately. Poor adherence to medication may represent one mechanism to explain why Type D cardiac patients experience poor clinical outcome, in comparison to non-Type D patients. Interventions, which target the self-management of medication, may be useful in these high-risk patients.

Does assertive community treatment increase medication adherence for people with co-occurring psychotic and substance use disorders?

This study analyzed data from a randomized trial to examine the impact on medication adherence of integrated treatment delivered via assertive community treatment (ACT) versus standard clinical case management (SCCM). Data from the original study included 198 study participants with co-occurring psychotic and substance use disorders who were randomly assigned to receive integrated treatment via ACT or SCCM and were followed for 3 years. We applied mixed-effects logistic regression to estimate group (ACT vs. SCCM) by time effects on a self-report measure of medication adherence. Adherence was dichotomized as 20% or more missed medication days ("poor adherence") versus less than 20% missed medication days ("adequate adherence"). Participants who were assigned to ACT reported significant improvement in medication adherence compared with those assigned to SCCM. Integrated treatment delivered via ACT may benefit persons with co-occurring psychotic and substance use disorders who are poorly adherent to medications.

Improving the measurement of self-reported medication nonadherence: Response to Authors

Improving the measurement of self-reported medication nonadherence: Response to Authors

A Simple Single-Item Rating Scale to Measure Medication Adherence: Further Evidence for Convergent Validity

Self-report measures of medication adherence are inexpensive and minimally intrusive. However, the validity of self-reported adherence is compromised by recall errors for missed doses and socially desirable responding. Examined the convergent validity of 2 self-report adherence measures administered by computerized interview: (a) recall of missed doses and (b) a single-item visual analogue rating scale (VAS). Adherence was also monitored using unannounced phone-based pill counts that served as an objective benchmark. The VAS obtained adherence estimates that paralleled unannounced pill counts (UPCs). In contrast, self-reported recall (SR-recall) of missed medications consistently overestimated adherence. Correlations with participant characteristics also suggested that the computer-administered VAS was less influenced by response biases than SR-recall of missed medication doses. A single-item VAS offers an inexpensive and valid method of assessing medication adherence that may be useful in clinical as well as research settings.

Comparison of two self-rating instruments for medication adherence assessment in hypertension revealed insufficient psychometric properties

Objective In cases of insufficiently controlled blood pressure, it is important for practitioners to distinguish between “nonadherence” and “nonresponse” to antihypertensive drug treatment. A reliable and valid adherence measurement based on the patient's self-report may be helpful in daily practice. Study Design and Setting In a primary care sample with 353 hypertensive patients, we applied two self-rating instruments to assess medication adherence (the “Hill-Bone Compliance to High Blood Pressure Therapy Scale” and Morisky's “Self-Reported Measure of Medication Adherence”) and compared their psychometric properties. Results Both scales showed low acceptability and insufficiency to moderate internal consistency (Cronbach's α = 0.25 and 0.73, respectively). Their convergent validity as indexed by kappa = 0.39 could be judged as “fair” at best. Testing the power to predict blood pressure >140/90 mm Hg, both scales showed an accuracy of 57% and 62%, respectively. The positive likelihood, that is, the increase in likelihood of high blood pressure in cases of nonadherence was 1.00 and 1.32, respectively. Conclusion The use of both scales cannot be recommended. They showed considerable floor effects, and their ability to identify medication adherence was inconsistent for nearly every third patient. The power of both scales to predict uncontrolled blood pressure was essentially a chance. The underlying conceptual framework of medication adherence therefore needs to be rethought.

A large-scale validation study of the Medication Adherence Rating Scale (MARS)

Adherence to medication is an important predictor of illness course and outcome in psychosis. The Medication Adherence Rating Scale (MARS) is a ten-item self-report measure of medication adherence in psychosis [Thompson, K., Kulkarni, J., Sergejew, A.A., 2000. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophrenia Research. 42. 241–247]. Although initial results suggested that the scale has good reliability and validity, the development sample was small. The current study aimed to establish the psychometric properties of the MARS in a sample over four times larger. The scale was administered to 277 individuals with psychosis, along with measures of insight and psychopathology. Medication adherence was independently rated by each individual's keyworker. Results showed the internal consistency of the MARS to be lower than in the original sample, though adequate. MARS total score correlated weakly with keyworker-rated adherence, hence concurrent validity of the scale appeared only moderate to weak. The three factor structure of the MARS was replicated. Examination of the factor scores suggested that the factor 1 total score, which corresponds to the Medication Adherence Questionnaire [Morisky,D.E., Green,L.W. and Levine,D.M., 1986. Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care. 24, 67–74] may be a preferable measure of medication adherence behaviour to the total scale score.

Adherence Analysis Using Visual Analog Scale Versus Claims-Based Estimation

Although visual analog scales (VAS) have been used frequently in outcomes research, there is little evidence regarding the validity of this scale for measuring medication adherence. To determine whether a VAS self-report measure of medication adherence is concordant with claims-based measurement of adherence. A mail survey was conducted in 2005 of persons with diabetes. Prescription claims were obtained for the 1985 survey respondents who used oral diabetes medications and lipid-modifying drugs. The self-reported measure of adherence was a VAS scored 0-100%, and the claims-based measure was the continuous measure of medication gaps (CMG), reverse-coded to yield a score of 0-100%. Dichotomous measures (highly adherent vs poorly adherent) were also created from the VAS and CMG using a cutoff value of 80%. For diabetes and lipid-modifying drugs, the scores on the VAS and CMG (continuous versions) were compared using a Pearson correlation coefficient, while the concordance of the dichotomous versions of the measures was compared using the kappa coefficient. The mean +/- SD for the VAS and CMG for oral diabetes drugs were 95.9 +/- 9.2 and 84.1 +/- 19.2, respectively, and for lipid-modifying drugs, 95.2 +/- 11.2 and 85.3 +/- 20.0, respectively. The VAS-diabetes and CMG-diabetes scales were moderately correlated (r = 0.22), as were the VAS-lipid and CMG-lipid (r = 0.26). The majority (69.0%) of subjects had consistent adherence classifications across the dichotomous versions of VAS-diabetes and CMG-diabetes (kappa = 0.13), while 73.1% of subjects had consistent classifications for the dichotomous VAS-lipid and CMG-lipid (kappa = 0.19). The VAS self-reports of adherence to medications had moderate concordance with estimates derived from drug benefit claims. Although the majority of subjects were consistently classified by the VAS and claims, the concordance may not be sufficient for direct comparisons of studies using VAS data with studies using claims-based estimates.

Rates and correlates of HIV treatment adherence among late middle-aged and older adults living with HIV disease

A growing number of older adults in the USA are contracting new HIV infections, and more persons living with HIV are living longer due to medical treatment advances. New treatments for HIV disease can improve immune functioning and decrease AIDS-related mortality. However, older persons living with HIV may not respond well to treatment and may experience difficulties adhering to complex medication regimens. One hundred and thirteen late middle-aged and older adults living with HIV (aged 47-69 years) were administered measures of demographic, medical and psychological characteristics. Eighty-four of these patients were currently prescribed antiretroviral medication for treatment of HIV, and this sub-set of participants completed brief self-report measures of medication adherence. Nearly one-third (31%) of older adults reported skipping medication doses in the past week. Education level, satisfaction with patient-provider relationships, physical wellbeing, alcohol use, perceptions of life stressor burden, a...

Rates and correlates of HIV treatment adherence among late middle-aged and older adults living with HIV disease

A growing number of older adults in the USA are contracting new HIV infections, and more persons living with HIV are living longer due to medical treatment advances. New treatments for HIV disease can improve immune functioning and decrease AIDS-related mortality. However, older persons living with HIV may not respond well to treatment and may experience difficulties adhering to complex medication regimens. One hundred and thirteen late middle-aged and older adults living with HIV (aged 47-69 years) were administered measures of demographic, medical and psychological characteristics. Eighty-four of these patients were currently prescribed antiretroviral medication for treatment of HIV, and this sub-set of participants completed brief self-report measures of medication adherence. Nearly one-third (31%) of older adults reported skipping medication doses in the past week. Education level, satisfaction with patient-provider relationships, physical wellbeing, alcohol use, perceptions of life stressor burden, anxiety and somatization distinguished patients reporting consistent versus inconsistent adherence. Less education, poorer relationships with physicians, greater alcohol use and higher levels of somatization uniquely predicted adherence problems in a multivariate model. Reasons for nonadherence most frequently cited by older adults are presented and recommendations are offered regarding adherence-related domains that should be monitored and addressed among older adults receiving HIV care.

Congruence of Three Self-Report Measures of Medication Adherence Among HIV Patients

AbstractOBJECTIVE:To evaluate the accordance between three measures of self-reported medication adherence.METHODS:A survey was administered to HIV patients. The three adherence measures included a four-item Morisky-type scale (Measure1) and two measures defining adherence as the percentage of doses taken as prescribed during the past two days (Measure2) or past two weeks (Measure3).RESULTS:For Measure1, 29.2% of the patients were categorized as high adherence and 61.5% as medium adherence. For Measure2 and Measure3, the mean scores were 93.6% and 96.5%, respectively. Using 90% as cutoff values, 78.5% and 95.4% of the patients were classified as adherent by Measure2 and Measure3, respectively (k = 0.30; p = 0.001). When 80% was used, 90.8% of the patients were classified as adherent for Measure2 and 96.9% for Measure3 (k = 0.48; p < 0.001). When using 90% and 80% as cutoff values to categorize Measure2 and Measure3 as three levels, there was no agreement between Measure1 and the other two measures. The accordance of Measure2 and Measure3 was significant albeit not high (k = 0.31; p < 0.001).CONCLUSIONS:The accordance between a Morisky-type adherence scale and measures of missed doses is unsatisfactory. However, “missed-dose” measures using two-day or two-week time periods yield fairly similar results. Researchers should be cautious when comparing adherence rates between studies that use different methods for assessing adherence. ResumenOBJETIVO:El objetivo fue evaluar la concordancia entre tres medidas de cumplimiento de terapia informado por pacientes.MÉTODOS:Se condujo una encuesta entre pacientes de VIH. Las tres medidas de cumplimiento incluyeron una escala tipo Morisky de cuatro ítemes. (Medida1) y dos medidas que definían cumplimiento como el porcentaje de dosis tomadas según prescritas en los pasados dos días (Medida2) o durante las pasadas dos semanas (Medida3).RESULTADOS:Para la Medida1, 29.2% de los pacientes se categorizaron de alto cumplimiento y 61.5% de mediano cumplimiento. Para las Medida2 y Medida3, la puntuación promedio fue 93.6% y 96.5%, respectivamente. Utilizando 90% como el valor límite, 78.5% y 95.4% de los pacientes fueron clasificados como cumplidores según la Medida2 y la Medida3, respectivamente (k = 0.30, p = 0.001). Utilizando 80%, 90.8% de los pacientes fueron clasificados como cumplidores según la Medida2 y 96.9% según la Medida3 (k = 0.48, p < 0.001). Cuando se utilizó 90% y 80% como los valores límite para categorizar la Medida2 y la Medida3 en tres niveles, no hubo concordancia entre la Medida1 y las otras dos medidas. La concordancia de la Medida2 y la Medida3 fue significativa aunque no alta (k = 0.31, p < 0.001).CONCLUSIONES:La concordancia entre una escala de cumplimiento tipo Morisky y las medidas para omisión de dosis es insatisfactoria. Sin embargo, las medidas de “dosis omitidas” que utilizan períodos de tiempo de dos días o de dos semanas rinden resultados casi similares. Los investigadores deben ser cautelosos al comparar tasas de cumplimiento entre estudios que utilizan distintos métodos para evaluar cumplimiento. RésuméOBJECTIF:Évaluer la conformité entre trois mesures d'observance de la médication obtenues auprès des patients.MÉTHODES:Un questionnaire a été distribué à des patients infectés par VIH. Les trois mesures d'observance étaient les suivantes: une série de quatre questions de type Morisky (Mesure1), et deux mesures définissant l'observance sous forme de pourcentage des doses prises telles que prescrites durant les deux derniers jours (Mesure2) ou durant les deux dernières semaines (Mesure3).RÉSULTATS:Pour la Mesure1, l'observance a été classifiée comme élevée pour 29.2% des patients et comme moyenne pour 61.5% des patients. Pour la Mesure2 et la Mesure3, les résultats moyens d'observance ont été de 93.6% et de 96.5%, respectivement. Si 90% des doses prescrites doivent être prises pour parler d'observance, 78.5% et 95.4% des patients ont été classifiés comme observants par la Mesure2 et la Mesure3, respectivement (k = 0.30, p = 0.001). Quand 80% des doses prescrites doivent être prises, 90.8% des patients ont été classifiés comme observants par la Mesure2 et 96.9% par la Mesure3 (k = 0.48, p < 0.001). Si on utilise les résultats obtenus avec les valeurs de 90% et de 80% pour classifier les Mesures2 et les Mesures3 en trois niveaux d'observance (élevée, moyenne, faible), il n'y a pas de concordance entre la Mesure1 et les deux autres mesures. La concordance entre la Mesure2 et la Mesure3 est significative quoique non élevée (k = 0.31, p < 0.001).CONCLUSIONS:La conformité entre une mesure d'observance de type Morisky et des mesures des “doses manquées” est médiocre. Cependant, les mesures des “doses manquées” utilisant des périodes de temps de deux jours ou de deux semaines donnent des résultats assez similaires. Les chercheurs devraient être prudents quand ils comparent des taux d'observance obtenus à partir d‘études qui utilisent des méthodes différentes pour évaluer l'observance.

Concurrent and predictive validity of a self-reported measure of medication adherence.

Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive validity of a structured four-item self-reported adherence measure (alpha reliability = 0.61), which can be easily integrated into the medical visit. Items in the scale address barriers to medication-taking and permit the health care provider to reinforce positive adherence behaviors. Data on patient adherence to the medical regimen were collected at the end of a formalized 18-month educational program. Blood pressure measurements were recorded throughout a 3-year follow-up period. Results showed the scale to demonstrate both concurrent and predictive validity with regard to blood pressure control at 2 years and 5 years, respectively. Seventy-five percent of the patients who scored high on the four-item scale at year 2 had their blood pressure under adequate control at year 5, compared with 47% under control at year 5 for those patients scoring low (P less than 0.01).