The Danish version of the Medication Adherence Report Scale: Preliminary Validation in Cancer Pain Patients

Objective:   To examine the psychometric properties of the Danish version of the Medication Adherence Report Scale (DMARS-4) adapted to measure adherence to analgesic regimen among cancer patients.
Methods:   The validated English version of the Medication Adherence Report Scale was translated into Danish following the repeated back-translation procedure. Cancer patients for the study were recruited from specialized pain management facilities. Thirty-three patients responded to the DMARS-4, the Danish Barriers Questionnaire II, The Danish version of Patient Perceived Involvement in Care Scale measuring the quality of patient-physician pain communication, and the Danish Brief Pain Inventory pain severity scale.
Results:   A factor analysis of the DMARS-4 resulted in one factor. Mean (SD) score on the cumulative scale ranging from 4 to 20, with higher scores indicating better medication adherence, was 17.8 (0.42). The DMARS-4 scores were related to the measures of patients' concerns about pain management and patients' pain communication. The internal consistency of the DMARS-4 was 0.70.
Conclusions:   The DMARS-4 seems to be a valid and reliable measure of self-reported adherence to analgesic regimen in the context of cancer 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。     

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.     

Medication adherence and predictive factors in patients with cardiovascular disease: A comparison study between Australia and Iraq

Background: Adherence to cardiac medication regimes is essential for effective treatment of cardiovascular disease but is unsatisfactory in Australia and little studied in Iraq.Aim: This study evaluated and compared adherence to cardiac medications and potentially predictive factors based on the Theory of Planned Behaviour (TPB) in patients with cardiovascular disease admitted to hospital and attending cardiac services in Australia and Iraq.Methods: A cross-sectional multi-centre comparative study involving 246 cardiac patients was conducted in Australia (one hospital in Sydney) and Iraq (three cardiac hospitals in Baghdad) between October 2016 and December 2017. Adherence to medications and related factors were examined using established, validated questionnaires, formally translated and validated into Arabic for Iraqi participants. Binary logistic regression was conducted to determine those factors independently predictive of cardiac medication adherence, in Australia and Iraq.Findings: A significantly higher proportion (64.3%) of Iraqi than Australian (37.5%) cardiac patients reported medium/low levels of adherence to their cardiac medications. After adjusting for confounding factors, the ability to correctly self-administer and refill medications, and beliefs about cardio-protective medication were identified as independent predictors of cardiac medication adherence behaviour in both Australian and Iraqi participants. In Iraq, patients recruited from out-patient cardiac clinics were significantly more likely to report adherent behaviours that patients recruited as in-patients of the cardiac ward.Conclusion: Non-adherence to cardiac medications differed but was sub-optimal in both Australian and Iraqi patient samples, in both countries, adherence was associated with patients’ beliefs about medications, and ability to self-administer and refill medications. Clinical nurses and pharmacists need to investigate these factors at every point in the cardiac trajectory to optimise medication adherence.     

Role of depressive symptoms and self‐efficacy of medication adherence in Korean patients after successful percutaneous coronary intervention

This cross‐sectional study sought to identify the prevalence of medication adherence and to explore the role of depression and self‐efficacy on medication adherence among patients with coronary artery diseases. Participants were recruited among outpatients who successfully underwent primary percutaneous coronary intervention (PCI) with drug‐eluting stent at academic medical centres in Cheonan, South Korea. Medication adherence was evaluated by the eight‐item Morisky Medication Adherence Scale using a validated Korean version. Prevalence of non‐adherent to medication was 60.3%. With non‐depressed and high self‐efficacy as reference and after adjusting for age and gender, the models showed that those with depression and low self‐efficacy are more likely to be non‐adherent to medication. Therefore, future studies should focus on the development of interventions designed to reduce depression and increase self‐efficacy for improving patient adherence to cardiovascular medications following PCI.     

Comparison of adherence to generic multi‐tablet regimens vs. brand multi‐tablet and brand single‐tablet regimens likely to incorporate generic antiretroviral drugs by breaking or not fixed‐dose combinations in HIV‐infected patients

Adherence to antiretroviral (ARV) is crucial to achieve viral load suppression in HIV‐infected patients. This study aimed to compare adherence to generic multi‐tablet regimens (MTR) vs. brand MTR likely to incorporate ARV drugs without breaking fixed‐dose combinations (FDC) and brand single‐tablet regimens (STR) likely to incorporate generics by breaking the FDC. Patients aged of 18 years or over exposed to one of the generic or the brand of lamivudine (3TC), zidovudine/lamivudine (AZT/TC), nevirapine (NVP), or efavirenz (EFV), or the brand STR of efavirenz/emtricitabine/tenofovir (EFV/FTC/TDF). Adherence was measured by medication possession ratio (MPR) using both defined daily dose (DDD) and daily number of tablet recommended for adults (DNT). Adherence to generic MTR vs. brand MTR and brand STR was compared using Kruskal–Wallis. The overall median adherence was 0.97 (IQR 0.13) by DNT method and 0.97 (0.14) by DDD method. Adherence in patients exposed to generic MTR (n = 165) vs. brand MTR (n = 481) and brand STR (n = 470) was comparable by DNT and DDD methods. In conclusion, adherence to generic MTR was high and comparable with adherence to brand MTR and to STR. Utilization of DDD instead DNT to measure the MPR led to small but nonsignificant difference that has no clinical impact.