Utility of the MARS-5 in Assessing Medication Adherence in IBD

Abstract

Introduction We aimed to validate the Medication Adherence Report Scale-5 (MARS-5) as a tool for assessing medication adherence in inflammatory bowel disease (IBD) and to determine predictors of medication adherence. Methods One hundred twelve (N = 112) adults with confirmed IBD participating in the longitudinal Manitoba Living With IBD Study were eligible. Demographics, IBD type, surgeries, disease activity (using the Inflammatory Bowel Disease Symptom Inventory and fecal calprotectin levels), perceived stress, and medication use were collected biweekly through online surveys. The MARS-5 scores were obtained at baseline and at 1 year. Correlation between medication monitoring data and MARS-5 scores was performed and the optimal MARS-5 cutoff point for adherence assessment determined. Predictors of medication adherence were assessed at both ≥90% and ≥80%. Results Participants were predominantly female (71.4%), mean age was 42.9 (SD = 12.8), and the majority (67.9%) had Crohn disease (CD). Almost half (46.4%) were taking more than 1 IBD medication, with thiopurines (41.9%) and biologics (36.6%) the most common. Only 17.9% (n = 20) were nonadherent at a <90% level; of those, 90% (n = 18) were using oral medications. The MARS-5 was significantly associated with adherence based on medication monitoring data at baseline (r = 0.48) and week 52 (r = 0.57). Sensitivity and specificity for adherence ≥80% and ≥90% were maximized at MARS-5 scores of >22 and >23, respectively. Having CD (OR = 4.62; 95% confidence interval, 1.36-15.7) was the only significant predictor of adherence. Conclusion MARS-5 is a useful measure to evaluate adherence in an IBD population. In this highly adherent sample, disease type (CD) was the only predictor of medication adherence.

Medication Belief is Associated with Improved Adherence to Exclusive Enteral Nutrition in Patients with Crohn’s Disease

“…Several studies have assessed oral medicine adherence in CD patient, 33 , 34 and reported a high non-adherence rate. For example, Kane et al showed that 43%~60% of IBD patients had non-adherence to medication.…”

Medication Adherence in Chronic Older Patients: An Italian Observational Study Using Medication Adherence Report Scale (MARS-5I)

“…The original version of the scale was also validated in English, to study other noncommunicable or chronic diseases, such as stroke, chronic obstructive pulmonary disease, or inflammatory bowel disease [24,25,27].…”

“…The Medication Adherence Report Scale (MARS© Prof. Rob Horne), a self-report questionnaire, originally developed in English, is described as one of the faster instruments to administer to patients, is easier for nurses to assess [24], and it is an appropriate scale to measure medication adherence in patients with non-communicable or chronic diseases [25]. The purposes of the present study were to (i) evaluate the levels of adherence to polypharmacy in spatiotemporally-oriented hospitalized patients, aged 65 years and older, with chronic diseases; and (ii) evaluate the possible association of polypharmacy adherence to the sociodemographic characteristics of the enrolled sample.…”

Medication Adherence in Korean Patients with Inflammatory Bowel Disease and Its Associated Factors

“…The scores calculated by this questionnaire range from 5 to 25, with higher scores indicating a higher degree of medication adherence. A score of 20 points or less, i.e., 80% or below, was defined as low medication adherence [23].…”

“…To date, few studies have analyzed the factors associated with medication adherence in patients with IBD, especially in an Asian context [13,15,20,21]. It is difficult to apply the results of previous studies on medication adherence that have been conducted in Western patients with IBD [14,17,22,23] or in Korean patients with other chronic diseases [24]. Hence, in our present study we analyzed the factors associated with medication adherence in Korean patients with IBD using a structured questionnaire.…”