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Exploring the Agreement Between Self-Reported Medication Adherence and Pharmacy Refill-Based Measures in Patients
Karumathil M Murali1,2, Judy Mullan2, Steven Roodenrys3
1Department of Nephrology, Wollongong Hospital, Wollongong, NSW, Australia.
Patient Preference and Adherence
|January 6, 2023
Summary
This study found modest agreement between self-reported adherence (MMAS) and pharmacy refill data (MPR, PDC) in kidney patients. Continuous assessment of medication adherence is recommended over categorization.
Area of Science:
- Pharmacoeconomics and Health Outcomes Research
- Clinical Pharmacy and Practice
- Nephrology and Kidney Disease Research
Background:
- Categorizing medication adherence using cut-off scores can lead to misclassification.
- Expressing adherence as a continuous variable may overcome categorization challenges.
- The validity of continuous self-reported adherence and its agreement with refill data are largely untested.
Purpose of the Study:
- To quantitatively and categorically assess agreement between pharmacy refill rates and self-reported adherence scales.
- To evaluate the utility of continuous variables for medication adherence measurement.
- To compare Medication Possession Ratio (MPR) and Proportion of Days Covered (PDC) with the Morisky Medication Adherence Scale (MMAS).
Main Methods:
- Cross-sectional study of 113 kidney disease patients (including dialysis) in Australia.
- Medication adherence assessed via MMAS, MPR, and PDC for antihypertensives and cardiometabolic drugs.
- Agreement analyzed using trend tests, ANCOVA, Cohen's kappa, and Bland-Altman analysis.
Main Results:
- Significant declining trends in MPR and PDC scores with worsening MMAS adherence categories.
- Adjusted ANCOVA revealed significant association between self-reported and pharmacy refill-based adherence (p < 0.001).
- Fair agreement (Cohen's kappa) and minimal bias (Bland-Altman) observed between MMAS and refill measures.
Conclusions:
- Modest agreement exists between pharmacy refill and self-reported MMAS adherence measures.
- Assessing medication adherence as a continuous variable is recommended to avoid misclassification.
- Findings support the use of continuous adherence metrics for better patient management.
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