Assessing reported adherence to pharmacological treatment recommendations. Translation and evaluation of the Medication Adherence Report Scale (MARS) in Germany

Objectives Patients' self‐report of medicine taking is a feasible method of assessing their adherence to prescribed pharmacological treatment. Aim of this study was to assess whether the German version of the Medication Adherence Report Scale (MARS‐D) is an appropriate instrument for measuring patient adherence. Methods After translation into German, the questionnaire was sent to 1488 patients with chronic diseases and patients with risk factors of cardiovascular disease. Reliability and validity of the MARS‐D were assessed and compared with the psychometric properties of the original English version. The relationship between patients' characteristics and adherent behaviour was estimated using bivariate correlation and a linear regression model. Results The MARS‐D was analysed if patients were taking medicines and the MARS‐D was complete leaving 523 (35.1%) analysable questionnaires. Internal consistency of the MARS‐D (Cronbach's α 0.60–0.69) was satisfactory and comparable to the English original (Cronbach's α 0.69–0.90). Test–retest reliability was satisfactory (Pearson's r 0.61–0.63), however, lower than in the English sample (r = 0.97). Convergent validity was low but showed statistical significance. Patient socio‐demographic characteristics had weak influence on MARS‐D score indicating high reported adherence for older patients (P < 0.05), patients with German mother tongue (P < 0.05) and high number of medicines (P < 0.01). Conclusions Preliminary psychometric evaluation of the MARS‐D is encouraging. MARS‐D is an appropriate measure to detect patients at risk of non‐adherence. The MARS‐D could be used in routine care to support communication about the medication taking behaviour, as self‐report of non‐adherent behaviour corresponds to the facts.     

Analgesic adherence measurement in cancer patients: comparison between electronic monitoring and diary

Adherence to analgesics in cancer patients has scarcely been studied. In this study, the Medication Event Monitoring System (MEMS) and medication diaries were compared with respect to feasibility and adherence measurements. Forty-six outpatients with nociceptive pain caused by cancer were asked to use MEMS for their analgesics and to record their medication usage in a diary for four weeks. Seventy-nine percent of the patients used MEMS for the full four-week period; 70% did so for the diary. The majority of patients were satisfied with both MEMS and diary. Adherence data assessed by MEMS and diary were comparable. Patients used the amount of analgesics adequately (taking adherence: 87%) but took them irregularly (timing adherence: 53%). Subgroup analyses in patients using single and multiple analgesic regimens confirmed the comparable suitability of both methods. MEMS and a medication diary are equally useful for analgesic adherence measurement in cancer patients with pain.     

中文版8条目Morisky服药依从性量表在2型糖尿病患者中的信效度评价及应用研究

目的评价中文版8条目Morisky服药依从性量表（MMAS-8）在2型糖尿病患者中应用的信度、效度,探讨不同因素对患者服药依从性的影响。 方法选取2014年7月至2015年1月就诊于昆明医科大学第一附属医院的148例2型糖尿病患者,进行中文版MMAS-8及4条目Morisky服药依从性量表（MMAS-4）的调查。对中文版MMAS-8,选用Cronbach′s α系数评价其内部一致性信度,选用组内相关系数（ICC）评价重测信度;采用主成分因子分析法评价结构效度,采用Spearman相关系数评价聚合效度。对血糖达标组与血糖未达标组中文版MMAS-8得分采用两独立样本t检验进行比较,对血糖达标组与血糖未达标组服药依从性分布采用χ²检验进行比较,评价中文版MMAS-8区分效度。对2型糖尿病患者服药依从性影响因素采用多因素有序多分类logistic回归方法进行分析。 结果中文版MMAS-8的Cronbach′s α系数为0.776,ICC为0.854（P<0.05）;主成分因子分析法共提取3个公因子;MMAS-8与MMAS-4评分的相关系数为0.878（P<0.001）;血糖达标组（糖化血红蛋白<7%）MMAS-8得分高于血糖未达标组（糖化血红蛋白≥7%）,差异具有统计学意义［（7.20±1.04）vs（5.94±2.03）,t=3.910,P<0.001］,两组间低、中等、高依从性分布比较,差异有统计学意义（χ²=14.554,P=0.010）。影响2型糖尿病患者服药依从性的多因素有序多分类logistic回归分析提示：男性患者较女性患者服药依从性低（OR=0.405,95%CI=0.197~0.829,P=0.013）;职工医保患者较自费患者服药依从性低（OR=0.130,95%CI=0.021~0.800,P=0.028）;单药治疗较联合治疗患者依从性高（OR=2.970,95%CI=1.499~5.882,P=0.002）。年龄、病程、学历、职业、BMI、并发症、合并症、胰岛素治疗与否对服药依从性无显著影响,差异无统计学意义（P均>0.05）。 结论中文版MMAS-8具有良好的信度、效度;2型糖尿病患者的服药依从性与性别、医保类型及降糖方案有关。     

Medication adherence in patients with chronic non-malignant pain: Is there a problem?

Health care providers, treating patients with chronic non‐malignant pain, often experience that medication is not as effective as expected. It is important to realize that the effectiveness of a pharmacological treatment can be influenced by the way the medication is taken. Medication adherence is a topic that gains more attention, especially in chronic conditions, because it affects treatment outcome. A systematic review of studies on medication adherence in patients with chronic non‐malignant pain was performed to gain insight in the prevalence of the problem, the impact on treatment outcome, influencing variables and interventions. Searching several electronic databases (Medline, CINAHL, Psychinfo and Cochrane), 14 relevant articles were found. The results indicate that medication non‐adherence is common in patients with chronic non‐malignant pain. Both overuse and underuse of medication occurs. However, due to the scarce literature and important methodological limitations, it is not possible to make firm conclusions concerning the impact on outcome, influencing variables and optimal intervention strategies. This review highlights some important gaps in the adherence literature in a chronic non‐malignant pain population and sets the stage for future research.     

Intervening at the Intersection of Medication Adherence and Health Literacy

Medications play a prominent role in the treatment of many illnesses. Failing to adhere to prescribed medication regimens contributes to an array of poor health outcomes. In addition to the cost in terms of human suffering, the financial cost of medication nonadherence is staggering. Poor health literacy has been identified as a major cause of medication nonadherence. This paper focuses on nonadherence related to health literacy in the older adult population in the United States. Eight simple interventions to aid health care personnel in working with this population to improve adherence are provided.     

Expanding the Framework of Assessing Adherence and Medication-Taking Behavior

ABSTRACT

This analysis critiques recently published concepts of medication adherence assessment and elucidates the importance of finding new measures of adherence. Improving concepts and methods of adherence assessment is key to improving adherence outcomes. It proposes a new framework that contains more inclusive concepts and more standardized terminology. These new concepts and terms not only describe adherence and its specific measures in more detail, but also describe all medication-taking behavior. It argues for the integration of and measurement of behavior associated with specific dose times, types, or schedules. Last, it describes promising research enabled by the new framework that, if implemented, might lead to improved adherence.     

Medication trends and documentation of pain management following surgery

The purpose of the present study was to examine prescribing and administering activities for sedative and analgesic medication in postoperative patients, and to describe nurses' documentation practices for pain management in nursing notes. A prospective audit was undertaken of medication order charts and nursing notes of 100 patients on the operation day and over the first four days following surgery. Almost all patients received some form of infusion, while the use of 'as required' analgesics varied from one-third to over two-thirds of patients during the postoperative period. Few patients were prescribed fixed-order analgesics or sedative medications. An audit of nursing entries found that nurses had documented inadequately in four major areas: pain assessment, use of non-pharmacological interventions, use of pharmacological interventions, and outcome of interventions. The findings contribute to improving our understanding of nurses' pain management and identify the need to use clinical judgement that is individualized to patients' needs.