Self-reported Morisky Medication Adherence Scale Research Articles

Exploring the Agreement Between Self-Reported Medication Adherence and Pharmacy Refill-Based Measures in Patients with Kidney Disease.

To assess the quantitative and categorical agreement between two methods of measuring medication adherence: pharmacy refill-based medication possession rates and self-reported medication adherence scale. Categorisation of adherence metrics using empirical cut-off scores can lead to misclassification, which can be overcome by expressing adherence as a continuous variable. Pharmacy refill-based adherence can be reported as actual rates, but the validity of expressing self-reported medication adherence scores as a continuous variable to reflect adherence is unknown and its quantitative agreement with refill-based adherence rates untested. Patients with kidney disease, including dialysis patients, from Illawarra Shoalhaven region of New South Wales, Australia were recruited between January 2015 and June 2016 to this cross-sectional study. Medication adherence was assessed using the self-reported Morisky Medication Adherence Scale (MMAS) and two pharmacy refill-based measures, Medication Possession Ratio (MPR) and Proportion of Days Covered (PDC) for antihypertensives and cardiometabolic drugs. Categorical and quantitative agreement between self-reported adherence and pharmacy refill-based adherence were assessed using tests of trend, analysis of covariance (ANCOVA), Cohen's kappa and Bland-Altman analysis. We recruited 113 patients. There was a significant declining trend of MPR (p < 0.001) and PDC (<0.001 for antihypertensives, p = 0.004 for cardiometabolic) scores among categories with worsening MMAS adherence. Adjusted ANCOVA showed significant association between self-report and pharmacy refill-based adherence (p < 0.001). Weighted Cohen's kappa statistics showed fair agreement between the self-report and pharmacy refill-based categories. Bland-Altman's analysis showed less than 5% of cases were outside the limits of agreement (-0.36 to 0.27) and the bias for MMAS was negative (-0.05 to -0.09), indicating MMAS did not overestimate adherence. There is modest agreement between pharmacy refill-based measures and self-report MMAS measures when assessed categorically or quantitatively. Assessing adherence as a continuous variable should be considered to overcome the challenges associated with categorization of adherence based on arbitrary thresholds.

Adherence to Treatment by Patients with Type 2 Diabetes Mellitus at Monze Mission Hospital, Monze, Zambia

Background: Diabetes mellitus (DM) is one of the most common non-communicable diseases and among the leading causes of disability, morbidity and mortality globally. The study assessed adherence to treatment by type 2 DM patients aged 20 years and above at Monze Mission Hospital in Monze district, Zambia. Research questions: 1) What is the level of adherence to treatment by type 2 DM patients receiving care from Monze Mission Hospital? 2) What factors influence adherence to treatment by type 2 DM patients? Methods: The study was conducted in 2017. It was a cross-sectional design. Simple random sampling method was used to select respondents and data was collected using a structured interview schedule. Data was entered and analyzed using the modified self-reported Morisky Medication Adherence Scale with six scores, modified self-care management questionnaire and IBM© Statistical Package for Social Sciences. Chi-Square was used to test associations between variables and binary logistic regression was used for multivariate analysis. The Morisky Medication Adherence scale was interpreted as follows: patients who scored between 4 - 6 points on knowledge had high knowledge while those who scored between 1 - 3 points had low knowledge about the disease. Results: The sample size of the study was 138 respondents. The study showed, only 44.2% of respondents had good adherence to treatment as they scored above 4 using the Morisky Medication Adherence Scale. Majority of the patients (55.6%) had knowledge about treatment despite 65.2% of respondents reported distance and financial challenges as hindrances to adherence. The study revealed a statistical association between adherence and knowledge of type 2 DM treatment. Conclusion: The study showed that poor adherence to treatment reduced as knowledge about DM increased. There is need to consider educational programs to strengthen adherence to dietary advice, regular exercise and follow up, to achieve normal glycemic levels.

Assessing Oral Medication Adherence and Identifying Predictors of Low Adherence in Chinese Inflammatory Bowel Disease Patients.

BackgroundPoor medication adherence in inflammatory bowel disease (IBD) had a negative impact on disease outcomes. In this study, we aimed to determine predictors of low adherence in the Chinese IBD populations and also aimed to compare a self-reported scale to a pharmacy refill index in assessing adherence of 5-ASA and azathioprine taken by Chinese IBD patients.Patients and MethodsAdult patients with IBD who had been taking 5-ASA or azathioprine for at least 3 months were recruited from hospital outpatient clinics. The MPR was calculated from previous six-month pharmacy refill data and the self-reported Morisky Medication Adherence Scale (MMAS-8) was issued through QR code questionnaires. Intentional and unintentional adherence scores were calculated according to specific items. Non-adherence was defined as MMAS-8 scores <6 or MPR < 0.8.ResultsThe response rate in the IBD patients was as high as 97%. 5-ASA non-adherence rate assessed by MPR was 30% and 37% by MMAS-8, and azathioprine non-adherence rate assessed was 33% by both MPR and MMAS-8. In a linear regression analysis, MPR value was significantly correlated with MMAS-8 score in 5-ASA group (r=0.4, p=0.003), and significantly correlated with unintentional adherence score (r=0.47, p<0.001). No significant correlation was observed between MPR value and MMAS-8 score in azathioprine group. Multivariate analysis demonstrated that age (OR: 1.08; 95% CI: 1.02–1.13; P=0.0015) and previous abdominal surgery (OR: 3.18; 95% CI: 2.09–4.27; P=0.04) were associated with high medication adherence. While patients who had small intestine lesion (OR: 0.09; 95% CI: 0.01–0.17; P=0.006) were associated with low adherence.ConclusionPredictors of low adherence were young age, lesions on small intestine, whereas previous abdominal surgery was a protective factor. This study also demonstrated that the MMAS-8 scale was a valid instrument for assessing 5-ASA adherence in IBD patients. Unintentional non-adherence was significantly related to the total non-adherence, which would allow to use the tool to seek ways for adherence improvement.

Adherence to Therapy in Chronic Obstructive Pulmonary Disease: A Systematic Review.

Adherence to therapy plays a key role in treatment optimization and clinical outcome in patients with chronic obstructive pulmonary disease (COPD). The adherence to inhaled medications is poor, ranging from 20% to 60%. In this study we searched Medline and PubMed literature regarding factors that could have an impact on therapy adherence in COPD patients, using the key words "COPD" or "chronic obstructive pulmonary disease" and "adherence". The search was limited to the English language article published between January 2013 and December 2019. Review papers, study protocols, and meta-analyses were excluded. The final material included 25 articles. The evaluation was performed using the Cochrane Review Manager guidelines. The 25 articles represented 29 countries from 5 continents. We assessed adherence to therapy and the impact of selected factors on the adherence in 27,660 COPD patients (60.9% of whom were male, mean age 64years). The factors affecting adherence were broken down into three categories: sociodemographic, clinical, and psychological. There were two standardized instruments used in the analyzed studies: Test of Adherence to Inhalers (TAI) and self-reported Morisky Medication Adherence Scale (MMAS-8). We found that 46.3% of patients had a moderately good level of adherence to inhaled therapy (TAI range around 50 points), while 41.6% of patients had a high level of adherence to oral therapy. The nature of non-adherence was in most cases inadvertent rather than an erratic or deliberate demeanor (48.5% vs. 38.9% vs. 42.4%, respectively). We conclude that standardized instruments enable the prediction of adherence to therapy and should be used in clinical practice. The assessment of adherence is essential for undertaking interventions to counteract plausible non-adherence. Collaboration between an educator and a psychologist is required to evaluate the patient's motivation and to ensure his comprehension of treatment prescribed.

Level of medication adherence to anti diabetic therapy in patients with type ii diabetes mellitus at selected hospital in chennai

Introduction:Worldwide, the adherence rate for medication for diabetes vary between 36 and 93%. Adherence to prescribed medication is crucial to reach metabolic control as non-adherence with blood glucose lowering or lipid lowering drug is associated with higher HbAIc and cholesterol, levels respectively. Aim: The main aim of the study was to assess the medication adherence to ant diabetic therapy in patients with type II diabetes mellitus. Methodology: A Cross sectional study was chosen Non-adherence was assessed using Patient’s self-reports of how they had been taking their medication in the week preceding the interview. The study was conducted in Saveetha Institute of Medical and Technical Science. The sample Size for the study is 100 diabetic clients and sampling technique is non-probability, purposive sampling technique. The sample who met the inclusion were selected for the study. The survey questionnaire comprised of two sections. The first section included questions on socio- demographic variable data and the tool of Adherence to treatment has been assessed during a personal interview with each patient using a questionnaire. Medication adherence to diabetes medicines was determined using a modified version of the four items, self-reported Morisky medication adherence scale. Collected data were analyzed descriptive and inferential statistics. Result: The assessment of the client’s answered for the 4-items of modified Morisky adherence predictor scale showed that 38 (38%) of the client’s had good adherence with prescribed medications, whereas 45(45%) % had medium adherence and 17 % had low adherence. Conclusion: Assessing the medication compliance among diabetes mellitus who all are taking with medications have effect of well reduced.

Exploring variables associated with medication non-adherence in patients with COPD.

Research has indicated that medication adherence is low and represents a barrier to achieve the desired health outcome in patients with Chronic Obstructive Pulmonary Disease (COPD). The aim of the study was to investigate the factors that are significantly associated with self-reported medication non-adherence in patients with COPD. Patients attending the outpatient respiratory clinic at the Royal Medical Services (RMS) Hospital in Amman. In addition to socio-demographics, validated measures including COPD knowledge questionnaire, the 4-item self-reported Morisky medication adherence scale, St George respiratory questionnaire and Health Anxiety and Depression scale were used in the present study. The stepwise logistic regression analysis was performed in order to identify variables that independently and significantly predicted medication non-adherence. Predictors of medication non-adherence. A total of 133 patients participated in the study. Results indicated that majority of the patients (61.7%) were non-adherent. According to the model, patients were four times more likely to be non-adherent if they reported having depression (OR 0.251, CI 0.24-0.76) and approximately eight times to have medication non-adherence if they suffered from comorbid illness (OR 0.119, CI 0.11-0.80). Study participants were found to have a double risk of medication nonadherence if they received an increase in the frequency of administration of their COPD medication (OR 0.524, CI 0.08-0.69) and being concerned about side effects (OR 0.515, CI 0.36-0.92). Depression, dosage regimen complexity, the presence of co-morbidities and therapy side effects have significantly influenced adherence to COPD therapy in the present study. Clinical pharmacists should provide emotional support, simplify dosage regimen, use adherence aids, elicit patients' concerns about their illness comorbidities, select treatments with less side effect and help the patients coping with side effects in order to enhance adherence and health outcomes in patients with COPD.

Adherence to adjuvant endocrine therapy in postmenopausal breast cancer patients: A 5-year prospective study

PurposeAdjuvant endocrine therapy (ET) in breast cancer reduces recurrence risk and increases overall survival. The aim of the study was to quantify non-adherence and discontinuation to ET in postmenopausal women with breast cancer, and identify possible clinical or social risk factors. MethodsWomen with hormone-receptor positive breast cancer (N = 138), mean age 58 (SD 9.3) years, filled in 4 questionnaires within 1–12, 24, 36 and 48–60 months after surgery; Subjective Health Complaints Inventory (SHC), Functional Assessment of Cancer Therapy-Social Support Subscale (FACT-ES), and Quality of Patient Information Questionnaire (QPI). Adherence to Tamoxifen (Tam) or Aromatase Inhibitors (AI) was examined using the self-reported Morisky Medication Adherence Scale (MMAS-8) and data from the Norwegian Prescription Database (NorPD). Kaplan-Meier curves and Cox proportional hazards regression models estimated adherence to ET. ResultsThe estimate of discontinued ET within 60 months was 38%. Self-reported discontinuation was 7% compared with 25% from the NorPD. Being overweight or obese were significantly time dependent factors predictive for discontinuing ET, p = 0.025. ConclusionCloser follow-ups, tailor-made information about the proven benefits of ET, and keeping a normal body mass index (BMI) may improve adherence to ET in postmenopausal women with breast cancer.

Perceived Health Control

To examine the role of perceived health control variables in psychiatric patients' adherence to prescribed treatment. Cross-sectional study including 966 consecutive adult Spanish psychiatric outpatients attended from October 2013 to April 2014 at community mental health services in the Canary Islands. Diagnoses were made using the ICD-10 criteria. Participants completed the 8-item self-report Morisky Medication Adherence Scale, Form C of the Multidimensional Health Locus of Control Scale, the General Self-Efficacy Scale, and the Hong Psychological Reactance Scale at their regular clinic visit. Sociodemographic and clinical variables were gathered. Logistic regression analyses were conducted to determine the predictive power of the variables studied. The present findings confirm that the control beliefs variables studied are related to psychiatric patients' self-reported adherence and support the dual health control hypothesis. This hypothesis specifies that the balance between internal and external health control beliefs (ie, the extent to which individuals attribute their health to their own actions or to external agents such as doctors, significant other people, or chance) is related to adherence to prescribed treatment. Results from logistic regression analysis indicated that health control beliefs interact with psychological reactance, exerting their effects on patients' adherence (12.8% of the variance explained and 64.2% of patients were correctly classified). It was found that low scores on both internal and external health control beliefs (P < .001) as well as low level of affective (P < .001) and cognitive (P < .001) psychological reactance best predicted self-reported adherence. The knowledge of control constructs beliefs in psychiatric outpatients could allow the psychiatrist to predict noncompliance, monitor patient progression more closely, and individualize patient education in an effort to increase treatment adherence in patients who have difficulties adhering to treatment plans.

The agreement of patient-reported versus observed medication adherence in type 2 diabetes mellitus (T2DM)

ObjectiveMedication adherence in type 2 diabetes mellitus (T2DM) improves glycemic control and is associated with reduced adverse clinical events, and accurately assessing adherence assessment is important. We aimed to determine...

Predictors of Adherence to Type2 Diabetes Medication.

Despite the effectiveness of drug therapy in diabetes management high rates of poor adherence persist. The purpose of this study was to determine the factors influencing the medication adherence and dietary regiment in type2 diabetic patients. This cross sectional study was conducted on 300 type2 diabetic patients referred to General Internal Medicine Clinic, Yazd Shohdaye Kargar Hospital,Yazd City, central Iran between September and December 2013. Each consented participant was interviewed by a trained study member using a questionnaire in three sections: Socio-demographic questions, self-reported Morisky medication adherence scale and Disease and medication beliefs Patient's questionnaire. Multivariable logistic regression model was developed to identify independent predictors of poor adherence. P<0.05 was considered statistically significant. Patients had diabetes for an average of 8.87 (SD: 6.0) yr with a mean age of 58.22 (SD: 10.27) yr. Totally, 101(33.7%) of the patients reported poor adherence with their diabetes medication. In multivariate analyses, good familial support (OR=0.11; 0.03, 0.37), and tendency to consume sweets (OR=1.21; 1.05, 1.39), belief about medication (OR=0.02; 0.018, 0.07) and tendency to consume vegetables (OR=0.75; 0.65, 0.88) were considered as predictive factors for poor adherence. Familial support, belief about medication, tendency to consume sweets and vegetables are logical goals for educational interventions to modify diabetes self-management.

Health care providers' support of patients' autonomy, phosphate medication adherence, race and gender in end stage renal disease.

This study was designed to assess dialysis subjects' perceived autonomy support association with phosphate binder medication adherence, race and gender. A multi-site cross-sectional study was conducted among 377 dialysis subjects. The Health Care Climate (HCC) Questionnaire assessed subjects' perception of their providers' autonomy support for phosphate binder use, and adherence was assessed by the self-reported Morisky Medication Adherence Scale. Serum phosphorus was obtained from the medical record. Regression models were used to examine independent factors of medication adherence, serum phosphorus, and differences by race and gender. Non-white HCC scores were consistently lower compared with white subjects' scores. No differences were observed by gender. Reported phosphate binder adherence was associated with HCC score, and also with phosphorus control. No significant association was found between HCC score and serum phosphorus. Autonomy support, especially in non-white end stage renal disease subjects, may be an appropriate target for culturally informed strategies to optimize mineral bone health.

Adherence to Immunosuppressive Medication in Renal Transplant Recipients From Follow-up Outpatient in China: Association of 2 Different Measurement Methods

PurposeOur aim was to investigate the association between self-report measure and serum concentration fluctuation of immunosuppressive medication (IM) in renal transplant recipients in China and examine the relationship between post-transplantation time and IM adherence. MethodsRenal transplant recipients at least 3 months post transplantation were recruited from a follow-up outpatient clinic. Both self-reported Morisky Medication Adherence Scale and serum concentration of IM (cyclosporine trough level and tacrolimus trough level) were used to measure drug adherence. FindingsTwo hundred and nine patients were recruited in the study. The majority of the patients received grafts from deceased donors (70.3%), were male (63.2%), and were married (83.3%). The nonadherence to IM was 31.7%, as measured by the Morisky Medication Adherence Scale. A statistically significant association between self-reported adherence and serum concentration fluctuation of tacrolimus trough level was identified (P < 0.001), but not for cyclosporine (P = 0.997). Serum concentration fluctuation of tacrolimus trough levels and self-report adherence of IM were associated with transplantation time (P < 0.001 and P = 0.003, respectively). ImplicationsThe Morisky Medication Adherence Scale appears valid in measuring drug adherence when compared with serum concentration fluctuation. Both self-report questionnaire and serum concentration fluctuation of tacrolimus changed with different post-transplantation time. These 2 measurements could be integrated into routine clinical practice for renal transplant recipients.

To what extent is treatment adherence of psychiatric patients influenced by their participation in shared decision making?

RationaleNonadherence to prescribed medications is a significant barrier to the successful treatment of psychiatric disorders in clinical practice. It has been argued that patient participation in shared decision making improves adherence to treatment plans.PurposeTo assess to what extent treatment adherence of psychiatric patients is influenced by the concordance between their preferred participation and their actual participation in decision making.Materials and methodsA total of 967 consecutive psychiatric outpatients completed the Control Preference Scale twice consecutively before consultation, one for their preferences of participation, and the other for the style they had usually experienced until then, and the eight-item self-report Morisky Medication Adherence Scale 8.ResultsMost psychiatric outpatients preferred a collaborative role in decision making. Congruence was achieved in only 50% of the patients, with most mismatch cases preferring more involvement than had been experienced. Self-reported adherence was significantly higher in those patients in whom there was concordance between their preferences and their experiences of participation in decision making, regardless of the type of participation preferred.ConclusionCongruence between patients’ preferences and actual experiences for level of participation in shared decision making is relevant for their adherence to treatment.

Effectiveness of nurse-led telephone follow-up in cardiac patients with type 2 diabetes mellitus

Background Nurse-led telephone follow-up has proven to be a successful mode of care for patients with diabetes mellitus (DM). This model of care includes; intensive education about diet, exercise, and treatment and could be the next step in the evolution of our telemedicine system. Objectives To investigate the effect of a nurse telephone follow-up in cardiac patients with type 2 DM on glycemic parameters and adherence to recommendations attending a nurse-led clinic at King Abdulaziz Cardiac Center. Methods This prospective quality improvement project invited all cardiac patients from October to December, 2011, who were unable to attend the clinic frequently, to participate. Inclusion criteria included documented coronary artery disease, type 2 DM on insulin with a current HbA1c > 8% for 6 months or more. All patients in this program receive care from a Cardiac Diabetic Nurse (CDN) according to the American Diabetic Association guidelines. In addition to this standard care, enrolled patients received a telephone call weekly for 12 weeks which reinforced education regarding diet, exercise, medication adherence and addressed additional patient problems. Medication adherence was measured using the validated self-report Morisky Medication Adherence Scale Mandatory variables collected at baseline and at 12 weeks included; body mass index blood pressure, fasting and postprandial blood glucose, HbA1c and total cholesterol screen. Statistical analysis Analysis was performed using SPSS advanced statistics for windows, version 18. Results and conclusion Pending

Use of a Screening Tool to Determine Nonadherent Behavior in Inflammatory Bowel Disease

Nonadherence is an issue in the management of inflammatory bowel disease (IBD), and no validated screening tool is available. We aimed to determine whether scores from a self-reported adherence survey correlated with pharmacy refill data as a reliable measure of medication adherence. We used the eight item, self-reported Morisky Medication Adherence Scale. Each question is worth a point, with a maximum score of 8. Pharmacies were contacted for refill information for the previous 3 months, then 3 and 6 months from enrollment. Refill data were recorded for each time interval as the medication possession ratio (MPR); adherence was defined as >80%. Analysis of variance was used to determine the relationship between survey scores and MPR by drug class. One hundred fifty outpatients were enrolled, of whom 94 had Crohn's disease and 56 had ulcerative colitis; 89 were female. At baseline, 47% of patients were on 5-aminosalicylic acid (5-ASA), 54% an immunomodulator, 15% infliximab, 8% an injectable biologic, and 6% budesonide. The median adherence score was 7. Fifty-two percent stated they "rarely" missed a dose of medication. The median adherence score, as defined by refill data, ranged from 0% (injectable biologic) to 75% (infliximab) by drug class. Only those on an immunomodulator had a survey score that positively correlated with adherence. Only those on a thiopurine were likely to have a score predicting adherence behavior. Adherence to therapy for IBD is complex and cannot be predicted reliably by a self-reported survey tool validated for other chronic conditions.

Psychometric Properties of the Thai Version of the 8-item Morisky Medication Adherence Scale in Patients with Type 2 Diabetes

A self-reporting questionnaire is the most convenient and cheapest way to assess medication adherence. A new 8-item self-reported Morisky Medication Adherence Scale (MMAS) has been developed and has shown better psychometric properties than the original 4-item Morisky scale. To examine the validity, including convergent known-groups and construct validity, and reliability, including internal consistency and test-retest reliability, of the MMAS in Thai patients with type 2 diabetes. The data were derived from a cross-sectional study. In a convenience sample, 303 type 2 diabetic outpatients were interviewed at the General Police Hospital in Bangkok, Thailand, between January and June 2007. Face-to-face interviews included MMAS, medication adherence visual analog scale (MA-VAS), and sociodemographic data. Medical records were reviewed for clinical data such as hemoglobin A(1C) (A1C) levels. Internal consistency reliability was moderate (Cronbach's alpha = 0.61), whereas the test-retest reliability of the MMAS was excellent (intraclass correlation coefficient = 0.83; p < 0.001). Concerning convergent validity, the MMAS had a high correlation with the 3-item Morisky scale (r = 0.77; p < 0.01) and a medium correlation with the MA-VAS (r = 0.57; p < 0.01). Regarding known-groups validity, a significant association between MMAS and A1C levels was found (chi(2) = 6.7; p < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of the MMAS were 51%, 64%, 71%, and 43%, respectively. Our factor analysis showed that the MMAS had 3 dimensions including forgetting to take medications, stopping medications when feeling better or worse, and the complexity of the drug regimen. The 8-item MMAS can be a tool to aid in assessing medication adherence in diabetes. The poor sensitivity can be improved by increasing the number of the response choices and the cut-off score of the scale and by using specific words in some items. A modified Thai version of the 8-item MMAS may be needed.