Measuring Medication Adherence in Parkinson's Disease: A Systematic Review of Contributing Components in Rating Scales

Abstract

Background Poor medication adherence in chronic illnesses such as Parkinson's disease (PD) is a significant but potentially addressable issue if core components are systematically measured. Objective To assess whether rating scales used in PD adequately cover essential components of medication adherence. Methods We accessed 5 databases targeting articles published before October 2019 and using rating scales to measure medication adherence in PD. The ABC Taxonomy from the European Ascertaining Barriers to Compliance Consortium and World Health Organization recommendations were used as the evaluation standard of 5 essential adherence dimensions (patient‐based, health system–based, social‐based, therapy‐based, and health condition–based), 3 phases (initiation, implementation, and discontinuation), and 2 factors (intentional and nonintentional). Results We screened 192 and selected 16 studies, collectively using 5 medication adherence rating scales. No scale covered all essential components of medication adherence (dimensions, phases, factors). The Morisky Medication Adherence Scales were the most frequently used (11 studies), but they measure only 2 dimensions and phases. The Stendal Adherence to Medication Score (used in 1 study) measured all phases but only 2 dimensions, and the Brief Medication Questionnaire (used in 3 studies) measured 3 dimensions and 2 phases. Distinctions between intentional and nonintentional factors were not completely considered in any scale. Conclusions Although multiple studies target medication adherence in PD, the used scales did not measure all recommended components, highlighting the need to develop a sensitive, specific, and comprehensive tool for measuring medication adherence among patients with PD.

Prescription Pattern of Monoamine Oxidase B Inhibitors Combined with Levodopa: A Retrospective Observational Analysis of Italian Healthcare Administrative Databases

“…However, we would like to briefly discuss a very important issue related to the management of PD patients in real life, which we propose to properly address in a future analysis, in order to implement the still limited data on PD medication adherence. Indeed, it has been demonstrated that a low pharmacological drug adherence among PD patients is common and that it is a widespread phenomenon at all stages [ 33 , 34 ]. It can be related to patients’ intentional and non-intentional factors [ 33 ].…”

“…Indeed, it has been demonstrated that a low pharmacological drug adherence among PD patients is common and that it is a widespread phenomenon at all stages [ 33 , 34 ]. It can be related to patients’ intentional and non-intentional factors [ 33 ]. Among the latter, the multimorbidity and the increasing complexity of clinical conditions, together with progression, seem the most influencing factors and are increasingly characterized by motor symptoms and severe motor and non-motor complications.…”

“…Among the latter, the multimorbidity and the increasing complexity of clinical conditions, together with progression, seem the most influencing factors and are increasingly characterized by motor symptoms and severe motor and non-motor complications. Adherence is multidimensional and multifactorial, thus it is important to analyze the role of clinicians, health systems, other than the patient, the disease, and the therapy themselves [ 33 , 35 ], if only because, as PD progresses, its economic burden on healthcare systems, society and patients increases [ 36 ]. In general, these findings of possible undertreatment with MAO-BIs must be carefully taken into account when assessing patients in terms of adverse events and effectiveness in daily clinical practice.…”

The impact of poor medication knowledge on health-related quality of life in people with Parkinson’s disease: a mediation analysis

“…In particular, the presence of depression may impact how participants answer in selfreported questionnaire [51]. At this point, it is also of note to say that the measurement of nonadherence is complex and that the available instruments do not capture all aspects of this construct [52]. However, while the SAMS used in this study may not encompass all aspects of adherence, the key focus of the analysis was put on medication knowledge as a subfactor related to adherence.…”

Medication Adherence and Coping with Disease in Patients from a Neurological Clinic: An Observational Study

“…Applying the ABC Taxonomy from the European Ascertaining Barriers to Compliance Consortium 23 and World Health Organization recommendations, 24 a recent review on rating scales assessing adherence in Parkinson’s disease concluded that the SAMS – like the Morisky score – assesses both factors of adherence (intentional and non-intentional), and two out of five dimensions of adherence (namely patient and therapy). 25 Regarding the phases of adherence, the Morisky score and the SAMS assesses the implementation and discontinuation of medication, but the SAMS additionally assesses the initiation of medication.…”