An innovative treatment adherence tool

Abstract

Background Non-adherence in heart failure leads to hospital admissions and fatalities. The Morisky scale may be adequate in some clinical scenarios, yet the score is selected by balancing sensitivity and positive predictive values. Purpose To measure treatment adherence using a novel model that achieves a good outcome in pharmaceutical care. Material and methods The questionnaire was developed and validated in Maltese ‘Kwestjonarju ghall-Uzu tal-Medicina u l-pazjent’ (KUMP) and forward translated into English ‘Treatment adherence questionnaire’ (TAQ). The tool is a 13 item questionnaire with the last question embedding 7 sub-questions on various non-adherence scenarios. The questions tackle knowledge, patient self-care, access, communication and appropriate medicine use with six possible answer categories from ‘never’ to ‘always’. Scoring for parts A and B is different, to facilitate understanding of all of the questions by the individual respondent with a maximum score of 100. A higher score indicates higher adherence. Results The questionnaire’s good content coverage and acceptable item properties resulted in positive expert review ratings with a high reliability score (Κ=0.89; p<0.05). The tool was used to interview 50 heart failure patients (44–93 years). The mean score was 66% (n=50; SD=10) with the highest and lowest scores being 89 and 40, respectively. Only 4 patients (n=50) answered that they were never entitled to free medicines, attaining low adherence scores. 3 of the 46 patients admitted that they were confused with their prescribed medicines and needed a follow-up to organise their treatment charts for a smooth discharge. 2 of the 46 patients were buying other related medicines. 5 patients (n=50) confirmed that they had stopped taking a particular medicine, with 3 being readmitted due to such incidents. Conclusion The mean adherence score of the studied heart failure population sample indicated moderate adherence. Dichotomous questions do not allow the outcome of the appropriate answer since there are grey areas that cannot be captured. Therefore, the novel tool provided more insight and was simple and practical to use. The tool can be applied to other clinical scenarios.