Development and Evaluation of the Adherence to Refills and Medications Scale (ARMS) among Low-Literacy Patients with Chronic Disease

ObjectivesPatient literacy affects many aspects of medication use and may influence the measurement of adherence. The aim of the study is to design and evaluate a medication adherence scale suitable for use across levels of patient literacy.MethodsThe Adherence to Refills and Medications scale (ARMS) was developed, pilot tested, and administered to 435 patients with coronary heart disease in an inner-city primary care clinic. Psychometric evaluation performed overall and by literacy level, included an assessment of internal consistency, test–retest reliability, and factor analysis. Criterion-related validity was evaluated by comparing scores with Morisky's self-reported measure of adherence, medication refill adherence, and blood pressure measurements. Lexile analysis was performed to assess the reading difficulty of the instrument.ResultsThe final 12-item scale had high internal consistency overall (Cronbach's α = 0.814) and among patients with inadequate (α = 0.792) or marginal/adequate literacy skills (α = 0.828). Factor analysis yielded two subscales, which pertained to taking medications as prescribed and refilling medications on schedule. The ARMS correlated significantly with the Morisky adherence scale (Spearman's rho = ?0.651, P < 0.01), and it correlated more strongly with measures of refill adherence than did the Morisky scale. Patients with low ARMS scores (which indicated better adherence) were significantly more likely to have controlled diastolic blood pressure (P < 0.05), and tended to have better systolic blood pressure control. Lexile analysis demonstrated that the instrument had a favorable reading difficulty level below the eight grade.ConclusionThe ARMS is a valid and reliable medication adherence scale when used in a chronic disease population, with good performance characteristics even among low-literacy patients.     

Age‐related changes in blood pressure and heart rates of patients with Parkinson's disease

This study evaluated yearly changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rates (HR) for patients with Parkinson's disease (PD). Data were collected for the last 10 years from medical records of 28 PD patients and 30 non‐PD patients with other neurological disorders. Age‐related changes in each group were analyzed by year using mean values of SBP, DBP, and HR obtained at their bi‐monthly visits. In results, PD patients had a gradual decrease in SBP with longer disease duration, and mean SBP significantly decreased from Year 7–11 compared to the mean values for Year 1 (p < .001 or p < .01). In non‐PD patients, mean SBP significantly increased from Year 4–11 compared to the mean values for Year 1 (p < .001 or p < .01). This is the first study to report age‐related changes of BP in individual patients with PD over 10 years.     

Predictors of Health Care System and Physician Distrust in Hospitalized Cardiac Patients

Trusting relationships among patients, physicians, and the health care system is important in encouraging self-care behaviors in cardiovascular patients. This study aimed to assess the prevalence of health care system and physician distrust in this population, compare the 2 forms of distrust, and describe the demographic, socioeconomic, and psychosocial predictors of high distrust. A total of 1,232 hospitalized adults with acute coronary syndrome or heart failure were enrolled in a prospective, observational study assessing health care system distrust and physician distrust. High health care system distrust (35%) was observed across the population, with lower levels of interpersonal physician distrust (16%). In a multivariate analysis, poor social support and coping skills were strong predictors of both health care system (p = .026, p = .003) and physician distrust (p < .001, p = .006). Individuals with low or marginal health literacy had a higher likelihood of physician distrust (p < .001), but no relation was found between health literacy and health care system distrust. In conclusion, distrust is common among acutely ill cardiac patients. Those with low social support and low coping skills are more distrusting of physicians and the health care system.     

Ossification centres at the elbow joint in Bengali girls

Summary 313 healthy school girls from 6 to 16 years of age from middle income Bengali families were selected for a radiological study of norms of skeletal maturity at the elbow joint. The age of appearance and fusion of the four centres of the epiphyses at the lower end of the humerus and the centres for the head of the radius and top of the ulnar olecranon is reported. The 11th birthday seems to be an important landmark in growth when fusion commences at a rapid pace. By the thirteenth birthday the acceleration in growth is nearly complete. The skeletal maturity of the three long bones around the elbow joint was completed by the 16th birthday. From the All-India Institute of Hygiene and Public Health, Calcutta.