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Validation of self-reported adherence in chronic patients visiting pharmacies and factors associated with the overestimation and underestimation of good adherence

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Background

Studies validating indirect methods to identify nonadherence in chronic patients who visit pharmacies are lacking. The aim of this study was to validate self-reported adherence and assess the variables associated with both overestimation and underestimation of good adherence when using this method.

Materials and methods

An observational, cross-sectional study was undertaken to validate self-reported adherence in 132 community pharmacies throughout Spain in 6237 chronic patients. The Morisky-Green test was used as the validation method and through a 2 × 2 table, the validity indicators, predictive values, and likelihood ratios were calculated. To assess the variables associated with both overestimation and underestimation of good adherence, multivariate logistic regression analysis and calculation of the area under the ROC curve were used to evaluate discriminatory capacity.

Results

Sensitivity was 27.8% (95% CI: 26.2–29.4) and specificity was 93.9% (95% CI: 93.1–94.7). Discrepancy analysis obtained a significant overestimation of good adherence (p < 0.001). The factors associated with overestimating good adherence were performing a mnemonic trick (p < 0.001), not self-medicating (p < 0.001), a high level of physical activity (p < 0.001), and an older age (p = 0.014). Factors associated with underestimation were self-medication (p < 0.001), desiring more information (p < 0.001), smoking (p = 0.014), not engaging in physical activity in the low (p = 0.006) or high (p < 0.001) categories, having a younger mean age (p = 0.007), and taking two to three (p = 0.029) or four or more (p < 0.001) chronic treatments.

Conclusion

Self-reported adherence has good specificity but poor sensitivity. The associated profiles of the discrepancies were obtained to identify both good and poor adherence.

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References

  1. Perseguer-Torregrosa Z, Orozco-Beltrán D, Gil-Guillen VF, Pita-Fernandez S, Carratalá-Munuera C, Pallares-Carratalá V, Lopez-Pineda A (2014) Magnitude of pharmacological nonadherence in hypertensive patients taking antihypertensive medication from a community pharmacy in Spain. J Manag Care Spec Pharm 20:1217–1225

    PubMed  Google Scholar 

  2. García-Pérez LE, Alvarez M, Dilla T, Gil-Guillén V, Orozco-Beltrán D (2013) Adherence to therapies in patients with type 2 diabetes. Diabetes Ther 4:175–194

    Article  PubMed  PubMed Central  Google Scholar 

  3. Márquez Contreras E, Gil Guillén V, Casado Martínez JJ, Martel Claros N, De la Figuera von Wichmann M, Martín de Pablos JL, Atienza Martín F, Gros García T, Espinosa García J (2006) Analysis of studies published on hypertension treatment non-compliance in Spain between 1984 and 2005. Aten Primaria 38:325–332

    Article  PubMed  PubMed Central  Google Scholar 

  4. Piñeiro F, Gil V, Donis M, Orozco D, Torres MT, Merino J (1997) The validity of 6 indirect methods for assessing compliance with pharmacological treatment in dyslipidemias. Aten Primaria 19:465–468

    PubMed  Google Scholar 

  5. Piñeiro F, Gil V, Pastor R, Donis M, Torres MT, Merino J (1998) Factors involved in the non-compliance of the pharmacologic treatment of dyslipidemia. Aten Primaria 21:425–430

    PubMed  Google Scholar 

  6. Piñeiro F, Gil V, Donis M, Torres MT, Orozco D, Merino J (1997) Factors involved in noncompliance with drug treatment in non-insulin dependent diabetes mellitus. Aten Primaria 20:415–420

    PubMed  Google Scholar 

  7. Gil V, Muñoz C, Martínez JL, Belda J, Soriano JE, Merino J (1994) Factors involved in the hypertensive patient non-compliance with treatment. Med Clin (Barc) 102:50–53

    CAS  Google Scholar 

  8. Piñeiro F, Gil V, Donis M, Orozco D, Pastor R, Merino J (1997) Factors involved in noncompliance with pharmacological treatment in arterial hypertension. Aten Primaria 20:180–184

    PubMed  Google Scholar 

  9. Hashmi SK, Afridi MB, Abbas K, Sajwani RA, Saleheen D, Frossard PM, Ishaq M, Ambreen A, Ahmad U (2007) Factors associated with adherence to anti-hypertensive treatment in Pakistan. PLoS One 2:e280

    Article  PubMed  PubMed Central  Google Scholar 

  10. Vidal Flor M, Jansà Morató M, Galindo Rubio M, Penalba Martínez M (2018) Factors associated to adherence to blood glucose self-monitoring in patients with diabetes treated with insulin. The dapa study. Endocrinol Diabetes Nutr 65:99–106

    Article  Google Scholar 

  11. Jaam M, Ibrahim MIM, Kheir N, Awaisu A (2017) Factors associated with medication adherence among patients with diabetes in the Middle East and North Africa region: a systematic mixed studies review. Diabetes Res Clin Pract 129:1–15

    Article  PubMed  Google Scholar 

  12. Al-Foraih M, Somerset S (2017) Factors affecting adherence to statins in hypercholesterolemic Kuwaiti patients: a cross-sectional study. Med Princ Pract 26:35–40

    Article  PubMed  Google Scholar 

  13. Hennein R, Hwang SJ, Au R, Levy D, Muntner P, Fox CS, Ma J (2018) Barriers to medication adherence and links to cardiovascular disease risk factor control: the Framingham heart study. Intern Med J 48:414–421

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Margalef JC, Anadón SH, Ibars JB, Josa A, Crespo JM, Romero FB, Llor C (2011) Lifestyles of subjects who take drugs for two or more cardiovascular risk factors. TAR-RISC study. Aten Primaria 43:229–235

    Article  PubMed  Google Scholar 

  15. Torre Cisneros J, Fernández de la Puebla R, López-Miranda J, Nicolás Puiggari M, López-Segura F, Pérez-Jiménez F (1990) Treatment compliance and follow-up of arterial hypertension in an urban environment. Rev Clin Esp 187:103–106

    CAS  PubMed  Google Scholar 

  16. Gourzoulidis G, Kourlaba G, Stafylas P, Giamouzis G, Parissis J, Maniadakis N (2017) Association between copayment, medication adherence and outcomes in the management of patients with diabetes and heart failure. Health Policy 121:363–377

    Article  PubMed  Google Scholar 

  17. Gerada Y, Mengistu Z, Demessie A, Fantahun A, Gebrekirstos K (2017) Adherence to insulin self administration and associated factors among diabetes mellitus patients at Tikur Anbessa specialized hospital. J Diabetes Metab Disord 16:28

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kokoszka A (2017) Treatment adherence in patients with type 2 diabetes mellitus correlates with different coping styles, low perception of self-influence on disease, and depressive symptoms. Patient Prefer Adherence 11:587–595

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kuo SZ, Haftek M, Lai JC (2017) Factors associated with medication non-adherence in patients with end-stage liver disease. Dig Dis Sci 62:543–549

    Article  PubMed  Google Scholar 

  20. Ghimire S, Castelino RL, Lioufas NM, Peterson GM, Zaidi ST (2015) Nonadherence to medication therapy in haemodialysis patients: a systematic review. PLoS One 10:e0144119

    Article  PubMed  PubMed Central  Google Scholar 

  21. Valdés y Llorca C, Cortés-Castell E, Ribera-Casado JM, de Lucas-Ramos P, de Palacio-Guerrero LM, Mugarza-Borqué F, Casteig-Ayestarán, Díaz-Olmo J, Casteig-Blanco A, Gil-Guillén VF, Rizo-Baeza M (2020) Pharmacological non-adherence and associated factors in patients with chronic diseases who visit pharmacies in Spain

  22. Merino J, Gil VF, Cañizares R (2001) Métodos de medida del cumplimiento aplicados a las enfermedades cardiovasculares. Med Clin 116:38–45

    Article  Google Scholar 

  23. Piñeiro F, Gil V, Donis M, Orozco D, Pastor R, Merino J (1997) The validity of 6 indirect methods for assessing drug treatment compliance in arterial hypertension. Aten Primaria 19:372–376

    PubMed  Google Scholar 

  24. Gil V, Pineda M, Martínez JL, Belda J, Santos ML, Merino J (1994) Validity of 6 indirect methods to assess treatment compliance in arterial hypertension. Med Clin (Barc) 102:532–536

    CAS  Google Scholar 

  25. Gil VF, Belda J, Muñoz C, Martínez JL, Soriano JE, Merino J (1993) Validity of four indirect methods which evaluate therapeutic compliance for arterial hypertension. Rev Clin Esp 193:363–367

    CAS  PubMed  Google Scholar 

  26. Morisky DE, Green LW, Levine DM (1986) Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 24:67–74

    Article  CAS  PubMed  Google Scholar 

  27. Haynes RB, Sackett DL, Taylos DW, Souw JC (1979) Annotated and indexed on compliance of therapeutic and preventive regimens. In: Haynes RB, Taylor DB, Sackett DL (eds) Compliance in health care. Johns Hopkins University Press, Baltimore, pp 76–81

    Google Scholar 

  28. Gil VF, Belda J, Piñeiro F, Pascual R, Orozco D, Merino J (2001) El incumplimiento en la práctica clínica: toma de decisiones diagnósticas y terapéuticas. Med Clin 116:77–86

    Google Scholar 

  29. Choudhry NK, Fischer MA, Avorn J, Liberman JN, Schneeweiss S, Pakes J, Brennan TA, Shrank WH (2011) The implications of therapeutic complexity on adherence to cardiovascular medications. Arch Intern Med 171:814–822

    PubMed  Google Scholar 

  30. Grant RW, O'Leary KM, Weilburg JB, Singer DE, Meigs JB (2004) Impact of concurrent medication use on statin adherence and refill persistence. Arch Intern Med 164:2343–2348

    Article  PubMed  Google Scholar 

  31. Castellano JM, Sanz G, Peñalvo JL, Bansilal S, Fernández-Ortiz A, Alvarez L, Guzmán L, Linares JC, García F, D'Aniello F, Arnáiz JA, Varea S, Martínez F, Lorenzatti A, Imaz I, Sánchez-Gómez LM, Roncaglioni MC, Baviera M, Smith SC Jr, Taubert K, Pocock S, Brotons C, Farkouh ME, Fuster V (2014) A polypill strategy to improve adherence: results from the FOCUS project. J Am Coll Cardiol 64:2071–2082

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank the Foundation for Adherence to Treatment (FUNDOAT). Also, the authors thank Maria Repice for her help with the English version of the text.

Availability of data and materials

Anonymized versions of the interview data reported in this paper are available from the corresponding author on reasonable request.

Author information

Author notes

  1. C. Valdés y Llorca, J. M. Ribera-Casado, P. de Lucas-Ramos, L. M. de Palacio-Guerrero, F. Mugarza-Borqué and V. F. Gil-Guillén contributed equally to this work.

Authors and Affiliations

  1. Chair Adherence to Treatment, Miguel Hernández University, San Juan de Alicante, Alicante, Spain

    C. Valdés y Llorca, Ernesto Cortés-Castell, J. M. Ribera-Casado, P. de Lucas-Ramos, J. L. Casteig-Ayestarán, J. Díaz-Olmo, A. Casteig-Blanco, V. F. Gil-Guillén & M. Rizo-Baeza

  2. Scientific Committee Observatory Group Adherence to Treatment, Madrid, Spain

    C. Valdés y Llorca, Ernesto Cortés-Castell, J. M. Ribera-Casado, P. de Lucas-Ramos, L. M. de Palacio-Guerrero, F. Mugarza-Borqué & V. F. Gil-Guillén

  3. Department of Pharmacology, Pediatrics and Organic Chemistry, Miguel Hernández University, Ctra Valencia-Alicante S/N, 03550, San Juan de Alicante, Alicante, Spain

    Ernesto Cortés-Castell

  4. Observatorio para la Adherencia al Tratamiento (OAT), Madrid, Spain

    J. L. Casteig-Ayestarán, J. Díaz-Olmo & A. Casteig-Blanco

  5. Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain

    V. F. Gil-Guillén

  6. Department of Nursing, University of Alicante, San Vicente del Raspeig, Alicante, Spain

    M. Rizo-Baeza

Authors
  1. C. Valdés y Llorca
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  2. Ernesto Cortés-Castell
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  3. J. M. Ribera-Casado
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  5. L. M. de Palacio-Guerrero
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  6. F. Mugarza-Borqué
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  7. J. L. Casteig-Ayestarán
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  8. J. Díaz-Olmo
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  9. A. Casteig-Blanco
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  10. V. F. Gil-Guillén
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  11. M. Rizo-Baeza
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Corresponding author

Correspondence to Ernesto Cortés-Castell.

Ethics declarations

The study was approved by the Clinical Research Ethics Committee of the Spanish Agency of Medicines (Ref. OBS-MED-2015-01) and Medical Devices and by the Ethics Committee of the Clinical Hospital of Madrid (Ref. C.I. 15/251-E) and was carried out according to the standards for good clinical practice. No patient identification appeared in the data collection logbook, and the analysis was anonymized and encrypted. The patients were informed and were consented filling out the survey.

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The authors declare that they have no conflict of interest.

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Valdés y Llorca, C., Cortés-Castell, E., Ribera-Casado, J.M. et al. Validation of self-reported adherence in chronic patients visiting pharmacies and factors associated with the overestimation and underestimation of good adherence. Eur J Clin Pharmacol 76, 1607–1614 (2020). https://doi.org/10.1007/s00228-020-02950-9

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  • DOI: https://doi.org/10.1007/s00228-020-02950-9

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