Effectively measuring adherence to medications for systemic lupus erythematosus in a clinical setting

Abstract

Objective. To assess the reliability and concurrent validity of the Medication Adherence Self-report Inventory (MASRI) when used in systemic lupus erythematosus (SLE), to investigate the predictive validity of the MASRI using pharmacy refill information as the criterion standard, and to propose a sensible approach to the screening for nonadherence in a clinical setting. Methods. Adherence to 2 medications (hydroxychloroquine and prednisone) was measured in 55 patients using the MASRI, pill counts, and physician ratings (MD scale). Adherence based on pharmacy refill information served as a criterion standard with nonadherence defined as adherence rates <80%. To determine test-rest reliability of the MASRI, 20 patients completed the measure twice within a 2-week period. Results. Using pharmacy information, 39% of the patients were nonadherent to prednisone and 51% to hydroxychloroquine. The MASRI had acceptable internal consistency (Cronbach's ␣ 0.7) and good reliability. Irrespective of the drug assessed, MASRI ratings were moderately correlated with patient adherence (pharmacy), supporting the concurrent validity of the MASRI. The combination of adherence estimation by MD scale rating at <85% and by MASRI at <90% was 87% sensitive and 86% specific for identifying patients who were nonadherent to prednisone. These cutoff values also appeared suitable for identifying nonadherence to hydroxychloroquine. Conclusion. The MASRI is a reliable measure of adherence to medications in SLE. The measure has concurrent and predictive validity. When combined with the MD scale, the MASRI appears to be a useful screening tool for nonadherence in patients with SLE that could be suitable for clinical practice.

Therapeutic adherence in patients with systemic lupus erythematosus: a cross-sectional study

“…Thus, the group led by Koneru, 2008 found adherence to the general medication of 80%, when to GCS was 61%, much lower than adherence to GCS among the patients included in our study, who demonstrated adherence to GCS of 92.85% [11]. We also compared HCQ compliance in our patients who showed the adherence of 92.15% versus 49% in the study conducted by Koneru.…”

Patient Compliance with Proton Pump Inhibitor Therapy in an Otolaryngology Practice

“…Kimmel et al 12 reported that in a 32-week study analyzing 136 patients taking warfarin, 92% of patients had at least 1 inappropriate medication administration time and that 36% took their medication incorrectly at least 20% of the time. Koneru et al 13 found that among 50 patients with lupus, more than 50% of those studied were not adherent to their medications. In an analysis of 23 patients positive for human immunodeficiency virus, although 95% of the patients stated that their medications were life-prolonging, the rate of proper medication adherence was between 66% and 78%.…”

Intentional and unintentional treatment nonadherence in patients with systemic lupus erythematosus

“…Part A of the MASRI is 87% sensitive and 86% specific for identifying patients who were nonadherent (21). Part A consists of five 4-point scale items and one visual analog scale (VAS) item.…”