Measurement Properties of Patient-Reported Outcome Measures for Medication Adherence in Cardiovascular Disease: A COSMIN Systematic Review

Abstract

Background and Objective Several medication adherence patient-reported outcome measures (MA-PROMs) are available for use in patients with cardiovascular disease (CVD); however, little evidence is available on the most suitable MA-PROM to measure medication adherence in patients with CVD. The aim of this systematic review is to synthesise the measurement properties of MA-PROMs for patients with CVD and identify the most suitable MA-PROM for use in clinical practice or future research in patients with CVD. Methods An electronic search of nine databases (PubMed, MEDLINE, CINAHL, ProQuest Health and Medicine, Cochrane Library, PsychInfo, Scopus, Embase, and Web of Science) was conducted to identify studies that have reported on at least one of the measurement properties of MA-PROMs in patients with CVD. The methodological quality of the studies included in the systematic review was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Results A total of 40 MA-PROMs were identified in the 84 included studies. This review found there is a lack of moderate-to-high quality evidence of sufficient content validity for all MA-PROMs for patients with CVDs. Only eight MA-PROMs were classified in COSMIN recommendation category A. They exhibited sufficient content validity with very low-quality evidence, and moderate-to-high quality evidence for sufficient internal consistency. The 28 MA-PROMs that meet the requirements for COSMIN recommendation category ‘B’ require further validation studies. Four MA-PROMs including Hill–Bone Compliance Medication Scale (HBMS), the five-item Medication Adherence Report Scale (MARS-5), Maastricht Utrecht Adherence in Hypertension (MUAH), and MUAH-16 have insufficient results with high quality evidence for at least one measurement property and consequently are not recommended for use in patients with CVD. Two MA-PROMs (Adherence to Refills and Medications Scale [ARMS] and ARMS-7) are comprehensive and have moderate to high quality evidence for four sufficient measurement properties. Conclusion From the eight MA-PROMs in COSMIN recommendation category A, ARMS and ARMS-7 were selected as the most suitable MA-PROMs for use in patients with CVD. They are the most comprehensive with be best quality evidence to support their use in clinical practice and research. Supplementary Information The online version contains supplementary material available at 10.1007/s40261-022-01199-7.

Psychometric Properties of a Machine Learning–Based Patient-Reported Outcome Measure on Medication Adherence: Single-Center, Cross-Sectional, Observational Study

“…This is the first PROM including 5 items with responses scored on a 4-point Likert scale to study 3 dimensions of medication adherence (the patient, treatment, and disease). Decision trees are a reliable and effective decision-making technique that provides high classification accuracy with a simple representation of gathered knowledge [ 30 , 31 ] and have been used in various areas of medical decision-making [ 12 , 13 ]. In the medication adherence area, decision trees allow modeling of the complexity of adherence‐related behaviors of patients.…”

“…As medication adherence is a complex multifactorial behavior, it is important to propose accurate and easy-to-use tools for measuring medication adherence in daily medical practice to understand patient behavior toward medications. In this context, the use of patient-reported outcome measures (PROMs) is of great interest, as these self-reporting tools are able to address the problem of assessing subjective information about patients, such as their health priorities, experience, and perception of outcome, which are major aspects that explain medication nonadherence [ 12 ]. Data obtained using PROMs directly arise from the patient, without the involvement of the clinician’s interpretation.…”

“…Thus, PROMs are relevant tools to drive health care decision-making processes [ 13 ]. Medication adherence is an example of subjective behavior that can be captured using PROMs in clinical practice and research to guide decisions concerning the support and treatment benefits of medication adherence or harm of nonadherence [ 12 ]. PROMs are the most extensively used measures of medication adherence, in both research and clinical settings, for several reasons: they are easy to administer and inexpensive, take a short amount of time to collect the information, and can provide immediate feedback at the point of care and detect potential factors that influence adherence [ 14 ].…”

Innovative Approaches to Enhance and Measure Medication Adherence in Chronic Disease Management: A Review

“…These tools comprehensively cover adherence and discontinuation phases, supported by moderate-to high-quality evidence on fundamental measurement properties. Utilizing a user-friendly 4-point Likert scale, ARMS and ARMS-7 are available free of charge to students and non-profit organizations [61]. This conclusion is also upheld for medication adherence to antihypertensive drugs, showing that ARMS is the most promising free, non-inferior alternative to Morisky, the most commonly used scale [62].…”

Association between the Big Five personality traits and medication adherence in patients with cardiovascular disease: A cross-sectional study

“…Recent studies have focused on multiple aspects of medication “adherence,” a concept that includes patients’ understanding of medications and active participation in treatment decisions [ 6 ]. According to a recent systematic review, medication adherence scales with multidomain have been increasingly used in studies as patient-reported outcome measures [ 7 ]. Therefore, a multidisciplinary behavioral approach and effective patient–medical staff communication for the improvement of medication adherence, including patients’ attitude toward taking medications, play key roles in secondary prevention of CVD.…”