Medication adherence in adults after hospitalization for heart failure: A cross-sectional study

Background

Medication non-adherence in heart failure (HF) leads to increased mortality, morbidity and healthcare costs. However, no study has investigated HF patients' post-hospitalization medication non-adherence in Switzerland.

Objectives

Our primary aim was to assess the prevalence of post-discharge medication non-adherence in patients with HF. A secondary objective was to identify differences between fully and partially adherent patients regarding selected unplanned therapy-related inpatient/outpatient cardiology visits.

Methods

A non-experimental cross-sectional study was applied. The prevalence of medication adherence was assessed with a German-translated version of the Medication Adherence Report Scale (MARS-5) and analyzed descriptively. Differences between adherent and partially adherent patients' numbers of medications, dosing per day and 180-day unplanned inpatient stays or cardiology outpatient visits were explored.

Results

Of 153 recruited patients, 72 participated in the survey. Of these, 26.4 % were not fully adherent. Their most common reason was forgetfulness (23.7 %). There were no significant group differences regarding therapy-related variables or 180-day unplanned cardiology stays/visits.

Conclusions

Considering that over one-quarter of surveyed HF patients were not fully medication adherent, Swiss cardiology nurses need to be sensitized to this issue and trained in adherence-enhancing interventions. Reaching acceptable adherence levels in patients with HF will require further research and action.

Medication Adherence and Contributing Factors Among Type 2 Diabetes Patients at Adama Hospital Medical College in Eastern Ethiopia

Introduction

Good glycemic control and preventing early complications are the ultimate targets of diabetes management, which depends on patients' adherence to regimens. Even though highly potent and effective medications have been developed and manufactured with astonishing advancement over the past few decades, excellent glycemic control has remained elusive.

Objective

This study aimed to assess the magnitude and factors associated with medication adherence among type 2 diabetes (T2D) patients on follow-up at Adama Hospital Medical College (AHMC) in East Ethiopia.

Methods

A hospital-based cross-sectional study was conducted among 245 T2D patients on follow-up at AHMC from March 1 to March 30, 2020. Medication adherence reporting scale-5 (MARS-5) was utilized to collect information regarding patients' medication adherence. The data were entered and analyzed using SPSS (Statistical Package for Social Sciences) version 21. The level of significance was declared at a p-value of  < .05.

Results

Of the 245 respondents, the proportion of respondents who adhere to diabetes medication was 29.4%, 95% CI [confidence interval] (23.7%-35.1%). After adjusting for khat chewing and adherence to blood glucose testing as confounding factors, being married (AOR [adjusted odds ratio]  =  3.43, 95%CI [1.27-4.86]), government employee (AOR  =  3.75, 95%CI [2.12-7.37]), no alcohol drinking (AOR  =  2.25, 95%CI [1.32-3.45]), absence of comorbidity (AOR  =  1.49, 95%CI [1.16-4.32]), and having diabetes health education at health institution (AOR  =  3.43, 95%CI [1.27-4.86]) were the factors associated with good medication adherence.

Conclusion

The proportion of T2D patients who adhere to medication in the study area was remarkably low. The study also found that being married, government employee, no alcohol drinking, absence of comorbidity, and having diabetes health education at a health institution were the factors associated with good medication adherence. Therefore, imparting health education on the importance of diabetes medication adherence by health professionals at each follow-up visit should be considered. Besides, awareness creation programs regarding diabetes medication adherence should be considered using mass media (radio and television).

The Medication Adherence Report Scale: A measurement tool for eliciting patients' reports of nonadherence

Aims

This study aimed to establish the psychometric properties of a questionnaire measure of patients' adherence to medications to elicit patients' report of medication use in a variety of clinical samples. The reliability and validity were assessed in patients with hypertension. Additional analyses were performed on other patient groups.

Methods

Using a cross‐sectional study design, a 10‐item version of the Medication Adherence Report Scale (©Professor Rob Horne) was piloted in two samples of patients receiving treatment for hypertension (n = 50 + 178), asthma (n = 100) or diabetes (n = 100) at hospital outpatient or community clinics in London and the south‐east of England. Following principal components analysis, five items were retained to form MARS‐5 (©Professor Rob Horne). Evaluation comprised internal reliability, test‐retest reliability, criterion‐related validity (relationship with blood pressure control) and construct validity (relationship with patients' beliefs about medicines).

Results

The MARS‐5 demonstrated acceptable reliability (internal and test‐retest) and validity (criterion‐related and construct validity) in these patient groups. Internal reliability (Cronbach's α) ranged from 0.67 to 0.89 across all patient groups; test‐retest reliability (Pearson's r) was 0.97 in hypertension. Criterion‐related validity was established with more adherent hypertension patients showing better blood‐pressure control (χ² = 4.24, df = 1, P < .05). Construct validity with beliefs about medicines was demonstrated with higher adherence associated with stronger beliefs in treatment necessity and lower treatment concerns.

Conclusions

The MARS‐5 performed well on several psychometric indicators in this study. It shows promise as an effective self‐report tool for measuring patients' reports of their medication use across a range of health conditions.

Psychological predictors of adherence to oral hypoglycaemic agents: an application of the ProMAS questionnaire

Objectives: This study aimed to identify psychological predictors of oral hypoglycaemic agent (OHA) adherence and to compare adherence rates between a novel and well-known instrument, i.e. the Probabilistic Medication Adherence Scale (ProMAS) and Medication Adherence Report Scale (MARS-5).Design and main outcome measures: A longitudinal study design was applied with surveys at baseline and 6-month follow-up. At baseline, OHA adherence using the ProMAS and MARS-5, socio-cognitive determinants and demographics were assessed. At follow-up, the ProMAS was applied as outcome measure, on which socio-cognitive determinants and demographics were regressed using linear regression analysis.Results: The baseline and follow-up sample included 304 and 231 participants, respectively. When applying cut-off points of ≥15 for the ProMAS and ≥23 for the MARS-5, 47.4 and 89.5% adhered to their OHAs. Consistent predictors of better adherence comprised a low education, lower severity perceptions, and higher self-efficacy and intention. After correcting for baseline adherence, a low education and higher self-efficacy remained significant adherence predictors.Conclusions: Compared to the MARS-5, ProMAS data was less skewed, similar to objectively collected data, and yielded insights in a broader spectrum of (non)-adherence behaviours. Results stress the need for adherence improving interventions which particularly should target higher educated patients and patients with low self-efficacy, low intention and high severity perceptions.

Translation and initial validation of the Medication Adherence Report Scale (MARS) in Italian patients with Crohn's Disease

The MARS-5 (Medication Adherence Report Scale) was developed in English. The aim of this project was to analyse the MARS-5I (© Prof Rob Horne) psychometric properties and to identify whether its Italian translation is suitable for assessing medication adherence in Crohn Disease (CD) Italian patients. The MARS was translated and linguistically validated in Italian. The MARS-5I was used for evaluating medication adherence in the SOLE study, conducted in Italy on 552 subjects with CD. In order to un-bias the questionnaire results from the effects of treatment change and/or effectiveness, the analyses were performed on the 277 patients whose disease activity remained stable, selected among the 371 patients who maintained the same treatment between two consecutive visits. Internal consistency was high (Cronbach's alpha of 0.86). Pearson's correlation coefficient was 0.50 (p<0.001) and 0.86 (p<0.001- outliers removed), indicating satisfactory test-retest. MARS 5I scores were not correlated with Treatment Satisfaction Questionnaire for Medication but a small and statistically significant correlation was shown with physician-evaluated medication adherence, indicating convergent validity. MARS-5I, the Italian translation of the English MARS, showed satisfactory internal consistency and test-retest, and a low but statistically significant convergent validity. We confirmed the utility of this tool in patients with CD.

Correlation between adherence to antiepileptic drugs and quality of life in patients with epilepsy: A longitudinal study

OBJECTIVE

This study aimed to investigate whether the score of self-reported medication adherence using the Medication Adherence Report Scale (MARS-5) correlates with the serum level of antiepileptic medication, as well as whether the MARS-5 score can predict the quality of life (QoL) in patients with epilepsy.

METHODS

A longitudinal study was carried out. The patients with epilepsy who were prescribed a minimum of one antiepileptic drug were recruited (n=807). Each participant completed a background information sheet and the MARS-5 at baseline, followed by the Liverpool Seizure Severity Scale (LSSS) and Quality of Life in Epilepsy (QOLIE-31) questionnaire at 18-month follow-up. In addition, the serum level of antiepileptic medications was measured at the follow-up.

RESULTS

The MARS-5 score was negatively associated with the LSSS score (B=-0.089, SE=0.009, p<0.001) and positively correlated with the serum level of antiepileptic medications (B=3.200, SE=0.416, p<0.001), after adjusting for demographics and clinical characteristics. The serum level of antiepileptic drugs was significantly correlated with the overall QOLIE-31 score (B=3.118, SE=1.417, p=0.03). The MARS-5 score was significantly correlated with the overall QOLIE-31 scores and all the scores in the subcategories. In addition, the MARS-5 score was in line with the correlation between the LSSS and QOLIE-31 scores (Z=4.20, p<0.001) and between serum antiepileptic medication levels and QOLIE-31 score (Z=3.98, p<0.001).

CONCLUSIONS

The MARS-5 score can predict the QoL in patients with epilepsy for up to 18months. Therefore, healthcare providers may predict the QoL and drug adherence using the MARS-5 score, in order to design personalized interventions.

Is the MARS questionnaire a reliable measure of medication adherence in childhood asthma?

OBJECTIVE

To assess the reliability of the Medication Adherence Report Scale (MARS-5) for assessing adherence in clinical practice and research.

METHODS

Prospective cohort study following electronically measured inhaled corticosteroids (ICS) adherence for 1 year in 2-13-year-old children with persistent asthma. The relationship between electronically measured adherence and MARS-5 scores (ranging from 5 to 25) was assessed by Spearman's rank correlation coefficient. A ROC (receiver operating characteristic) curve was performed testing MARS-5 against electronically measured adherence. Sensitivity, specificity, positive and negative likelihood ratios of the closest MARS-5 cut-off values to the top left-hand corner of the ROC curve were calculated.

RESULTS

High MARS scores were obtained (median 24, interquartile range 22-24). Despite a statistically significant correlation between MARS-5 and electronically assessed adherence (Spearman's rho = 0.47; p < 0.0001), there was considerable variation of adherence rates at every MARS-5 score. The area under the ROC curve was 0.7188. A MARS-5 score ≥23 had the best predictive ability for electronically assessed adherence, but positive and negative likelihood ratios were too small to be useful (1.65 and 0.27, respectively).

CONCLUSIONS

Self-report using MARS-5 is too inaccurate to be a useful measure of adherence in children with asthma, both in clinical practice and in research.