Original Article| Volume 61, ISSUE 3, P282-288, March 2008

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An adherence self-report questionnaire facilitated the differentiation between nonadherence and nonresponse to antihypertensive treatment

  • Andreas Zeller
    Corresponding author. Medical Outpatient Department, University Hospital Basel, CH-4031 Basel, Switzerland; Tel.: +41-61-2655015; fax: +41-61-2654604.
    Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Cotham House, Cotham Hill, BS6 6JL Bristol, United Kingdom
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  • Knut Schroeder
    Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Cotham House, Cotham Hill, BS6 6JL Bristol, United Kingdom
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  • Tim J. Peters
    Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Cotham House, Cotham Hill, BS6 6JL Bristol, United Kingdom
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      To evaluate, among hypertensive patients, a brief adherence self-report questionnaire (ASRQ), using electronic monitors (medical event monitoring system, MEMS) as the gold standard comparator.

      Study Design and Setting

      A total of 239 patients with hypertension in five general practices in Bristol, UK completed the ASRQ before and at the end of the 4-week study period. Patients were asked to choose one of six descriptions (from level 1=perfect adherence to level 6=nonadherence) to express their medication taking. The main outcome measure was “timing adherence” (correct interdose intervals) as measured through electronic monitors.


      Most patients (89%) stated perfect or nearly perfect adherence, and data from the electronic monitors showed a mean timing adherence of 88.3% (n=216). Using the cutoff of those who reported ASRQ levels 1 and 2 (all tablets taken but not always at the same time of day), a high percentage of those with comparatively high adherence according to MEMS were correctly identified (specificity, 90–93%; negative predictive value, 66–96%). However, sensitivity (detection of true nonadherers) and positive predictive value were poor to moderate (14–42% and 22–66%, respectively).


      The questionnaire could be a useful aid to facilitate the difficult differentiation between nonadherence and nonresponse to prescribed antihypertensive medication.


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