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Effectively measuring adherence to medications for systemic lupus erythematosus in a clinical setting

  1. Sri Koneru1,
  2. Michael Shishov2,
  3. Avis Ware1,
  4. Yolanda Farhey1,
  5. Anne-Barbara Mongey1,
  6. T. Brent Graham2,
  7. Murray H. Passo2,
  8. J. Lawrence Houk1,
  9. Gloria C. Higgins3,
  10. Hermine I. Brunner2,*

Article first published online: 30 JUL 2007

DOI: 10.1002/art.22898

Issue

Arthritis Care & Research

Arthritis Care & Research

Volume 57, Issue 6, pages 1000–1006, 15 August 2007

Additional Information

How to Cite

Koneru, S., Shishov, M., Ware, A., Farhey, Y., Mongey, A.-B., Graham, T. B., Passo, M. H., Houk, J. L., Higgins, G. C. and Brunner, H. I. (2007), Effectively measuring adherence to medications for systemic lupus erythematosus in a clinical setting. Arthritis & Rheumatism, 57: 1000–1006. doi: 10.1002/art.22898

Author Information

  1. 1

    University of Cincinnati Medical Center, Cincinnati, Ohio

  2. 2

    Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

  3. 3

    Columbus Children's Hospital, and Ohio State University, Columbus

*Cincinnati Children's Hospital Medical Center, University of Cincinnati, William Rowe Division of Rheumatology, E 4010, 3333 Burnet Avenue, Cincinnati, OH 45229-3039

Publication History

  1. Issue published online: 30 JUL 2007
  2. Article first published online: 30 JUL 2007
  3. Manuscript Accepted: 12 FEB 2007
  4. Manuscript Received: 13 JUL 2006

Funded by

  • National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Numbers: P60-AR-47784, R03-AR-049860, U01-AR-51868
  • Columbus Medical Research Foundation

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Keywords:

  • SLE;
  • Adherence;
  • Compliance;
  • Lupus;
  • Adults;
  • Adolescents;
  • MASRI

Abstract

Objective

To assess the reliability and concurrent validity of the Medication Adherence Self-report Inventory (MASRI) when used in systemic lupus erythematosus (SLE), to investigate the predictive validity of the MASRI using pharmacy refill information as the criterion standard, and to propose a sensible approach to the screening for nonadherence in a clinical setting.

Methods

Adherence to 2 medications (hydroxychloroquine and prednisone) was measured in 55 patients using the MASRI, pill counts, and physician ratings (MD scale). Adherence based on pharmacy refill information served as a criterion standard with nonadherence defined as adherence rates <80%. To determine test–rest reliability of the MASRI, 20 patients completed the measure twice within a 2-week period.

Results

Using pharmacy information, 39% of the patients were nonadherent to prednisone and 51% to hydroxychloroquine. The MASRI had acceptable internal consistency (Cronbach's α 0.7) and good reliability. Irrespective of the drug assessed, MASRI ratings were moderately correlated with patient adherence (pharmacy), supporting the concurrent validity of the MASRI. The combination of adherence estimation by MD scale rating at <85% and by MASRI at <90% was 87% sensitive and 86% specific for identifying patients who were nonadherent to prednisone. These cutoff values also appeared suitable for identifying nonadherence to hydroxychloroquine.

Conclusion

The MASRI is a reliable measure of adherence to medications in SLE. The measure has concurrent and predictive validity. When combined with the MD scale, the MASRI appears to be a useful screening tool for nonadherence in patients with SLE that could be suitable for clinical practice.

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