Proposal for a Global Adherence Scale for Acute Conditions (GASAC): a prospective cohort study in two Emergency Departments

Abstract

4 Background: Adherence in the context of patients with acute conditions is a major public health issue. 5 It is neglected by the research community and no clinically validated generic scale exists to measure it. 6 Objective: To construct and validate a Global Adherence Scale usable in the context of Acute 7 Conditions (GASAC) that takes into account adherence both to advice and to all types of prescriptions 8 that the doctor may give. To measure adherence and to study its determinants. 9 Materials and method: We based the construction of the GASAC questionnaire on a theoretical 10 model and a literature search. Then, between 2013 and 2014, we validated it in a prospective 11 observational study in two hospital emergency departments. Patients were contacted by phone about 12 one week after their consultation to answer several questionnaires, including GASAC and the Girerd 13 self-administered questionnaire about medication adherence as a control.14 Results: GASAC consists of four adherence subscales: drug prescriptions; blood test/ radiography 15 prescriptions; lifestyle advice and follow-up instructions. An analysis of the 154 sets of answers from 16 patients showed that the GASAC drug subscale had satisfactory internal coherence (Cronbach's alpha 17 = 0.78) and was correlated with the Girerd score, as was GASAC as a whole (p<0.01)). The median 18 score was 0.93 IQR [0.78-1] for a maximum value of 1 (n = 154). In multivariate analysis, infection 19 was more conducive of good adherence (cut off at ≥ 0.8; n=115/154; 74.7% [67.0-81.3]) than trauma 20 (OR 3.69;). The Doctor-Patient Communication score (OR 1.06 by score point, CI 21 [1.02-1.10]) also influenced adherence.22 Conclusions: GASAC is a generic score to measure all dimensions of adherence in emergency 23 departments for clinical research and the evaluation of clinical practice. The level of adherence was 24 high for acute conditions and could be further improved by good Doctor-Patient Communication.