ObjectiveTo develop and validate an instrument to assess adherence to each individual drug taken by patients undergoing long-term treatment.DesignMulticentre prospective observational validation study.SettingSix general practitioners' clinics and 6 university hospitals in Paris, France.ParticipantsPatients 18 years and older receiving at least one long-term treatment.MethodsThe instrument was developed from a literature search and interviews with experts. Clarity and wording were assessed during pilot testing with 51 patients. The tool was validated in a sample of consecutive patients. We assessed agreement between adherence measured with our tool and drug diaries and compared measurements from our instrument with (1) the Lu instrument; (2) the Adherence Estimator (AE); (3) patient's adherence assessed by physicians; (4) the Morisky Medication Adherence Scale-4 items (MMAS-4); and (5) the Treatment Burden Questionnaire (TBQ). Reliability was assessed by a test–retest method.ResultsA total of 243 patients taking 961 drugs were recruited in 2014. We found good agreement between adherence measured by our tool and drug diaries (intraclass correlation coefficient (ICC) 0.69, 95% CI 0.34 to 0.91) and a linear relationship between measurement with our tool and (1) the Lu instrument (p<0.01); (2) 2 items of the AE (perceived need for medication (p<0.01) and concerns about medication (p<0.01)); (3) patients' adherence assessed by their physicians (p<0.01); (4) the MMAS-4 (p<0.01) and (5) the TBQ (p<0.01). Reliability of the retest was good (ICC 0.67, 95% CI 0.42 to 0.85).ConclusionsWe developed an instrument with acceptable validity and reliability to assess adherence for each drug taken by patients, usable in hospital and primary care settings.
PURPOSE Among patients on long-term medical therapy, we compared (1) patient and physician assessments of drug adherence and of drug importance and (2) drug adherence reported by patients with drug importance as assessed by their physicians.METHODS We recruited to the study patients receiving at least 1 long-term drug treatment from both hospital and ambulatory settings in France. We compared drug adherence reported by patients and drug importance assessed by physicians using Spearman correlation coefficients. Reasons for nonadherence were collected with open-ended questions and classified as intentional or unintentional.RESULTS Between April and August 2014, we recruited 128 patients taking 498 drugs. Patients and physicians showed only weak agreement in their assessments of drug adherence (r = -0.25; 95% CI, -0.37 to -0.11) and drug importance (r = 0.07; 95% CI, 0.00 to 0.13). We did not find any correlation between physician-assessed drug importance and patient-reported drug adherence (r = -0.04; 95% CI, -0.14 to 0.06). In all, 94 (18.9%) of the drugs that physicians considered important were not correctly taken by patients. Patients intentionally did not adhere to 26 (48.1%) of the drugs for which they reported reasons for nonadherence. CONCLUSIONSWe found substantial discordance between patient and physician evaluations of drug adherence and drug importance. Nearly 20% of drugs considered important by physicians were not correctly taken by patients. These findings highlight the need for better patient-physician collaboration in drug treatment. 2016;14:415-421. doi: 10.1370/afm.1965. INTRODUCTION N onadherence, defined as the extent to which a person's behavior fails to coincide with medical advice, may lead to negative outcomes and long-term mortality, 1,2 especially among patients with chronic conditions and on complex medication regimens. 3,4 Approximately 50% of patients stop taking their medications 6 months after drug initiation. 3,5 Reasons for nonadherence go beyond simple forgetfulness. Patients' perceptions and beliefs are crucial in their medication-taking behaviors. 6 Two types of drug nonadherence are usually distinguished: intentional and unintentional. 4,7 Intentional nonadherence is an active decision by patients who decide not to take medications as prescribed because of beliefs, 8 perceived need or benefit, 9 side effects, or burden of treatment. Unintentional nonadherence is a passive process whereby patients fail to adhere to treatments because of circumstances beyond their control. Ann Fam Med 7Individual adherence to the different drugs a patient takes can therefore vary considerably, 10,11 with various consequences depending on the drug or disease of interest. 12Not all drugs patients take have the same impact on their health outcomes: some are intended to prevent complications, others to reduce symptoms. Physicians and patients may differentially balance the need for each drug, which can result in a discordance in their priorities. 416In this study, we aimed to investigate...
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