Development and validation of an instrument to assess treatment adherence for each individual drug taken by a patient

Sidorkiewicz, Stéphanie; Tran, Viet-Thi; Cousyn, Cécile; Perrodeau, Élodie; Ravaud, Philippe

doi:10.1136/bmjopen-2015-010510

Cited by 44 publications

(46 citation statements)

References 42 publications

(56 reference statements)

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“…As with other researchers [6], we believe that, despite the DAI’s great usefulness, there is room for improvement even without modifying its original questions, but rather, by improving and simplifying the scoring procedures. Pharmacophobia is what Feinstein [7] would call a clinimetric general index since it is a measure of general health and functional states that are not distinctive for a particular disease or condition but influence adherence to all kinds of medications, not just psychiatric medication.…”

supporting

confidence: 57%

A Clinimetric Approach for Improving the Measurement of Pharmacophobia with Replication in Two Other Samples

Cuevas

Leon

2019

Psychother Psychosom

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supporting

confidence: 57%

A Clinimetric Approach for Improving the Measurement of Pharmacophobia with Replication in Two Other Samples

Cuevas

Leon

2019

Psychother Psychosom

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“…First, adherence to the drug was assessed by use of a validated self-report adherence instrument that we developed in a previous study. 16 This 5-item tool illustrates items by practical examples and pictographs to assess drug adherence and provide information about behaviors during drug intake. The results generate adherence levels ranging from 1 (high drug adherence) to 6 (drug discontinuation).…”

Section: Patient Assessmentsmentioning

confidence: 99%

“…(eg, omission, drug side effect, too much medication to take)." We evaluated the clarity of the question during cognitive testing in a previous study 16 by a double interview method. Discrepancies between what was intended and what was understood by patients were noted to adapt the wording.…”

Section: Patient Assessmentsmentioning

confidence: 99%

“…19 Our version for evaluation by physicians showed acceptable content validity during cognitive testing in a previous study. 16 Second, we asked physicians to rate the importance of the drug by giving their best estimate of the drug's importance for patient health by using an 11-step rating scale ranging from 0 (not important) to 10 (very important). This scale was not validated.…”

Section: Physician Assessmentsmentioning

confidence: 99%

“…16 Second, we asked physicians to rate the importance of the drug by giving their best estimate of the drug's importance for patient health by using an 11-step rating scale ranging from 0 (not important) to 10 (very important). This scale was not validated.…”

mentioning

confidence: 99%

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Discordance Between Drug Adherence as Reported by Patients and Drug Importance as Assessed by Physicians

Sidorkiewicz

Tran

Cousyn

et al. 2016

The Annals of Family Medicine

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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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The necessity‐concern framework in the assessment of treatment adherence of psychiatric patients and the role of polypharmacy in a Spanish sample

Cuevas

Montesinos

León

2020

Human Psychopharmacology

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Objective: This study compares three measures (necessity and concern scores, the necessity-concern differential, and a skeptical attitude vs. three other attitudes) for studying the relationship between the necessity-concern framework and treatment adherence after considering the number of prescribed drugs. Methods:The sample included 588 consecutive adult psychiatric outpatients in the Canary Islands, Spain. The necessity-concern framework was assessed using a specific subscale of the Beliefs about Medicines Questionnaire. Adherence (yes/no) to 1,101 prescribed psychiatric drugs was assessed using the Sidorkiewicz adherence tool.Results: In the three logistic regression models including 1,101 drugs, with adherence as the dependent variable, the highly significant odds ratios (ORs) and their 95% confidence intervals (CIs) were (a) OR = 1.57 (CI = 1.37-1.79) for necessity and OR = 0.747 (CI = 0.660-0.847) for concern; (b) OR = 1.44 (CI = 1.32-1.58) for the necessity-concern differential; and (c) OR = 0.452 (CI = 0.343-0.597) for a skeptical attitude (yes/no), defined as low necessity and high concern. In patients taking five or six drugs, adherence was associated with extremely high/low ORs for necessity, concern, and the differential.Conclusion: If replicated, our results suggest clinicians need to pay careful attention to each drug in each patient taking five or six drugs, emphasize necessity, and listen carefully to patient concerns.attitude to health, health behavior, medication adherence, patient acceptance of health care/ drug effects, polypharmacy, psychopharmacology, treatment adherence and compliance

show abstract

Development and validation of an instrument to assess treatment adherence for each individual drug taken by a patient

Cited by 44 publications

References 42 publications

A Clinimetric Approach for Improving the Measurement of Pharmacophobia with Replication in Two Other Samples

A Clinimetric Approach for Improving the Measurement of Pharmacophobia with Replication in Two Other Samples

Discordance Between Drug Adherence as Reported by Patients and Drug Importance as Assessed by Physicians

The necessity‐concern framework in the assessment of treatment adherence of psychiatric patients and the role of polypharmacy in a Spanish sample

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