Abstract
Objectives
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.
Results
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).
Conclusion
The questionnaire could be a useful aid to facilitate the difficult differentiation
between nonadherence and nonresponse to prescribed antihypertensive medication.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical EpidemiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hypertension control: how well are we doing?.Arch Intern Med. 2003; 163: 2705-2711
- Hypertension treatment and control in five European countries, Canada, and the United States.Hypertension. 2004; 43: 10-17
- Clinicians and patients with hypertension: unsettled issues about compliance.Am Heart J. 1995; 130: 572-579
- Electronic compliance monitoring in resistant hypertension: the basis for rational therapeutic decisions.J Hypertens. 2001; 19: 335-341
- Relation between insufficient response to antihypertensive treatment and poor compliance with treatment: a prospective case–control study.BMJ. 2001; 323: 142-146
- Adherence to medication.N Engl J Med. 2005; 353: 487-497
- Microelectronic systems for monitoring and enhancing patient compliance with medication regimens.Drugs. 1995; 49: 321-327
- The electronic medication event monitor. Lessons for pharmacotherapy.Clin Pharmacokinet. 1997; 32: 345-356
- Concurrent and predictive validity of a self-reported measure of medication adherence.Med Care. 1986; 24: 67-74
- Presse Med. 2001; 30: 1044-1048
- Development of a scale to assess the compliance of hypertensive patients.Int J Nurs Stud. 2003; 40: 677-684
- Development and evaluation of a medication adherence self-efficacy scale in hypertensive African-American patients.J Clin Epidemiol. 2003; 56: 520-529
- The Brief Medication Questionnaire: a tool for screening patient adherence and barriers to adherence.Patient Educ Couns. 1999; 37: 113-124
- Adherence to antihypertensive medication assessed by self-report was associated with electronic monitoring compliance.J Clin Epidemiol. 2006; 59: 650-651
- Development of a questionnaire to investigate patient compliance with antirheumatic drug therapy.J Rheumatol. 1999; 26: 2635-2641
- The compliance-questionnaire-rheumatology compared with electronic medication event monitoring: a validation study.J Rheumatol. 2003; 30: 2469-2475
- Nurse-led adherence support in hypertension: a randomized controlled trial.Fam Pract. 2005; 22: 144-151
- 2003 European Society of Hypertension—European Society of Cardiology guidelines for the management of arterial hypertension.J Hypertens. 2003; 21: 1011-1053
- British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary.BMJ. 2004; 328: 634-640
- Health Measurement Scales.3rd ed. Oxford University Press, Oxford, UK2006 (36–37)
- Practical Statistics for Medical Research.Chapman & Hall/CRC, London1991
- Facts and fiction of poor compliance as a cause of inadequate blood pressure control: a systematic review.J Hypertens. 2004; 22: 1849-1855
- Adherence to Long-term Therapy—Evidence for Action.World Health Organization, Geneva, Switzerland2003
- Stata Statistical Software.StataCorp, College Station, TX2005
- Interventions for helping patients to follow prescriptions for medications.Cochrane Database Syst Rev. 2002; : CD000011
- Detection, adherence and control of hypertension for the prevention of stroke: a systematic review.Health Technol Assess. 1998; 2: i-78
- Compliance with antihypertensive treatment.Clin Exp Hypertens. 1996; 18: 463-472
- Electronic pill-boxes in the evaluation of antihypertensive treatment compliance: comparison of once daily versus twice daily regimen.Am J Hypertens. 2000; 13: 184-190
- The effect of prescribed daily dose frequency on patient medication compliance.Arch Intern Med. 1990; 150: 1881-1884
- Patterns of compliance with once versus twice daily antihypertensive drug therapy in primary care: a randomized clinical trial using electronic monitoring.Can J Cardiol. 1997; 13: 914-920
- Validation of patient reports, automated pharmacy records, and pill counts with electronic monitoring of adherence to antihypertensive therapy.Med Care. 1999; 37: 846-857
- A comparison of enalapril 20 mg once daily versus 10 mg twice daily in terms of blood pressure lowering and patient compliance.J Hypertens. 1999; 17: 1627-1631
- Compliance and antihypertensive efficacy of amlodipine compared with nifedipine slow-release.Am J Hypertens. 1998; 11: 478-486
- Comparison of the effects of a 7-day period of non-compliance on blood pressure control using three different antihypertensive agents.J Hypertens. 2004; 22: 1409-1414
- The Hawthorne effect—what did the original Hawthorne studies actually show?.Scand J Work Environ Health. 2000; 26: 363-367
- Contending paradigms for the interpretation of data on patient compliance with therapeutic drug regimens.Stat Med. 1998; 17: 251-267
- The use of self-measured blood pressure determinations in assessing dynamics of drug compliance in a study with amlodipine once a day, morning versus evening.J Hypertens. 1993; 11: 1403-1411
- Impact of an electronic medication compliance aid on long-term blood pressure control.J Clin Pharmacol. 1992; 32: 277-283
- Compliance declines between clinic visits.Arch Intern Med. 1990; 150: 1509-1510
Article info
Publication history
Published online: August 24, 2007
Accepted:
April 23,
2007
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.