Variation in medication adherence across patient behavioral segments: a multi-country study in hypertension

Abstract

ObjectivesThis study determines the following for a hypertensive patient population: 1) the prevalence of patient worldview clusters; 2) differences in medication adherence across these clusters; and 3) the adherence predictive power of the clusters relative to measures of patients’ concerns over their medication’s cost, side effects, and efficacy.MethodsMembers from patient panels in the UK, Germany, Italy, and Spain were invited to participate in an online survey that included the Medication Adherence Report Scale-5 (MARS-5) adherence instrument and a patient segmentation instrument developed by CoMac Analytics, Inc, based on a linguistic analysis of patient talk. Subjects were screened to have a diagnosis of hypertension and treatment with at least one antihypertensive agent.ResultsA total of 353 patients completed the online survey in August/September 2011 and were categorized against three different behavioral domains: 1) control orientation (n=176 respondents [50%] for I, internal; n=177 respondents [50%] for E, external); 2) emotion (n=100 respondents [28%] for P, positive; n=253 respondents [72%] for N, negative); and 3) agency or ability to act on choices (n=227 respondents [64%] for H, high agency; n=126 [36%] for L, low agency). Domains were grouped into eight different clusters with EPH and IPH being the most prevalent (88 respondents [25%] in each cluster). The prevalence of other behavior clusters ranged from 6% (22 respondents, INH) to 12% (41 respondents, IPL). The proportion of patients defined as perfectly adherent (scored 25 on MARS-5) varied sharply across the segments: 51% adherent (45 of 88 respondents) for the IPH vs 8% adherent (2 of 25 respondents) classified as INL. Side effects, being employed, and stopping medicine because the patient got better were all significant determinants of adherence in a probit regression model.ConclusionBy categorizing patients into worldview clusters, we identified wide differences in adherence that can be used to prioritize interventions and to customize adherence messages. Also, the predictive power of segments was greater than that for variables measuring concerns over cost, side effects, and efficacy.

Translation and initial validation of the Medication Adherence Report Scale (MARS) in Italian patients with Crohn’s Disease

“…It is a generic tool, which can be administered regardless of the disease and the prescribed drug. It has been validated so far in different clinical settings, namely statin therapy [15], rheumatoid arthritis [16], asthma [17], psychosis [18], and has been used for assessing adherence in many clinical studies worldwide [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37].…”

Influential Factors in Adherence to the Therapeutic Regime in Hypertension and Diabetes

“…(1) The low level of adherence to the therapeutic regime is well-known throughout the spectrum of chronic disease. (2) In developed countries, only 50% of the people who suffer from chronic disease comply with the prescribed treatment, while in developing countries this adherence may be lower because of the scarcity of resources and inequities in access to health services. (1,3) Lack of adherence is attributed to multiple factors; according to the World Health Organization, five dimensions exist that constitute the Multidimensional Model of Adherence: health system and staff, therapy, disease, patient, and socioeconomic aspects.…”

The Validity and Reliability Study of the Turkish Adaptation of Medical Adherence Report Scale

“…İUBÖ'nün orijinal çalışmasında ölçeğin tek faktörlü bir yapıdan oluştuğu, kriter ve ayırt edici geçerlilik bakımından iyi ve yeterli güvenilirliğe sahip olduğu (Cronbach Alp-ha=0.85) görülmüştür (16). Ölçek astım (24,25), KOAH (26), kardiyovasküler hastalıklar (23), diyabet (27), inflamatuvar bağırsak hastalığı (28), depresyon (27) ve bipolar bozukluklar (24) gibi kronik hasta popülasyonlarında ilaca uyumu değerlendirmek için kullanılmaktadır (17). Bunun yanında ölçeğin Almanca, Danca, Hintçe, Arapça, Lehçe, Yunanca, Fransızca, İtalyanca ve İspanyolca dillerine de uyarlaması mevcut olup, uyarlama çalışmalarında orijinal form ile benzer psikometrik özellikler gösterdiği görülmektedir (11,23 Ethics Committee Approval: This study was approved by Ethical Committee of Istanbul University, Social Sciences.…”