Self-reported medication adherence and pharmacy refill adherence among persons with ischemic stroke: a cross-sectional study

Abstract

Purpose To describe and compare self-reported medication adherence assessed with the 5-item version of Medication Adherence Report Scale (MARS-5) and pharmacy refill adherence based on data from the Swedish Prescribed Drug Register (SPDR) among persons with ischemic stroke, and to investigate independent predictors associated with respective assessments. Methods A study questionnaire was sent to persons with ischemic stroke registered in the Swedish Stroke Register between Dec 2011 and March 2012, and who lived at home 3 months after discharge. The primary outcome was dichotomized to adherent/non-adherent based on MARS-5 and SPDR and analyzed with multivariable logistic regression. Adherence according to MARS-5 was defined as score 23 or higher (out of 25). Adherence according to SPDR was defined as at least one filled statin prescription recorded in SPDR in each 6-month interval during 2 years of follow-up. Results Of 420 participants, 367 (87%) and 329 (78%) were adherent according to MARS-5 and SPDR, respectively, and 294 (70%) participants were adherent according to both assessments. A significant association was shown between medication adherence according to the two assessments (p = 0.020). Independent predictors associated with medication adherence according to MARS-5 were female sex, while factors associated with SPDR were male sex and being younger. Conclusions The majority of participants were classified as adherent, 87% according to MARS-5 and 78% based on data from SPDR. However, only 70% were adherent according to both MARS-5 and SPDR, and different predictors were associated with the different measurements, suggesting that these assessments are measuring different aspects of adherence.

Self-Reported Medication Adherence Among Older People Admitted to Hospital: A Descriptive Study

“…The adherence level in the present study is in line with results shown in previous studies using MARS-5 to study the implementation phase [ 28 , 29 , 31 – 33 ]. These studies focused on geriatric individuals and/or subjects with ischemic stroke or inflammatory bowel disease who were living at home.…”

“…The reported adherence level often varies with the population studied, the time at which the assessment is performed, or which methods are used to assess adherence [9,[34][35][36][37]. As has been shown in previous studies, the repartition of MARS-5 answers was skewed [28,29,31,33], suggesting that a recall bias or response bias cannot be ruled out.…”

“…It has been suggested that a combination of different methods to assess medication adherence may give more accurate results [42]. For example, in Norberg et al, self-reported adherence with MARS-5 was compared with more objective pharmacy refill adherence based on data from the Swedish Prescribed Drug Register, showing that 20% of the participants who were adherent according to MARS-5 were nonadherent according to the Swedish Prescribed Drug Register [33]. This study also showed that women had a higher odds of being classified as adherent than men as assessed with MARS-5, while men and younger age were associated with a higher odds of being adherent when assessed with the Swedish Prescribed We hypothesized that cognitive impairment would be a factor most likely to be significantly associated with adherence, as reported in several studies [13,[43][44][45][46][47].…”

“…Depression has been shown in meta-analyses to be associated with poorer adherence compared to nondepressed people [ 38 , 39 ]. In addition to depression, previous studies on older people have found various factors related to self-reported adherence, for example, polypharmacy, younger age, male sex, perceived medication regimen as being complicated, handling problems, perceived side effects, costs, large caregiver burden, impaired hearing, beliefs about medications, and concerns about the medication [ 6 , 9 , 14 , 33 , 40 , 41 ]. In addition to different settings and populations being studied, some of these studies combine different methods for assessing medication adherence, while others apply one method, as in the present study.…”

Young adult preferences for digital health interventions to support adherence to inhaled corticosteroids in asthma: a qualitative study

“…MARS scores range from 5 to 25, with higher scores indicating greater adherence. A score of ≥23 indicates adherence (Norberg, Sjölander, Glader, & Gustafsson, 2022 ).…”