Assessing the validity of self-reported medication adherence among inner-city asthmatic adults: the Medication Adherence Report Scale for Asthma.
ABSTRACT A validated tool to assess adherence with inhaled corticosteroids (ICS) could help physicians and researchers determine whether poor asthma control is due to poor adherence or severe intrinsic asthma.
To assess the performance of the Medication Adherence Report Scale for Asthma (MARS-A), a 10-item, self-reported measure of adherence with ICS.
We interviewed 318 asthmatic adults receiving care at 2 inner-city clinics. Self-reported adherence with ICS was measured by MARS-A at baseline and 1 and 3 months. ICS adherence was measured electronically in 53 patients. Electronic adherence was the percentage of days patients used ICS. Patients with a mean MARS-A score of 4.5 or higher or with electronic adherence of more than 70% were defined as good adherers. We assessed internal validity (Cronbach alpha, test-retest correlations), criterion validity (associations between self-reported adherence and electronic adherence), and construct validity (correlating self-reported adherence with ICS beliefs).
The mean patient age was 47 years; 40% of patients were Hispanic, 40% were black, and 18% were white; 53% had prior asthma hospitalizations; and 70% had prior oral steroid use. Electronic substudy patients were similar to the rest of the cohort in age, sex, race, and asthma severity. MARS-A had good interitem correlation in English and Spanish (Cronbach alpha = 0.85 and 0.86, respectively) and good test-retest reliability (r = 0.65, P < .001). According to electronic measurements, patients used ICS 52% of days. Continuous MARS-A scores correlated with continuous electronic adherence (r = 0.42, P<.001), and dichotomized high self-reported adherence predicted high electronic adherence (odds ratio, 10.6; 95% confidence interval, 2.5-44.5; P < .001). Construct validity was good, with self-reported adherence higher in those saying daily ICS use was important and ICS were controller medications (P = .04).
MARS-A demonstrated good psychometric performance as a self-reported measure of adherence with ICS among English- and Spanish-speaking, low-income, minority patients with asthma.
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ABSTRACT: Background. Psychological stress has been linked in some studies to asthma prevalence and outcomes in children. The authors sought to evaluate the relationship between perceived stress and morbidity among inner-city adults with asthma. Methods. The authors interviewed a prospective cohort of 326 moderate-to-severe asthmatics receiving care at two large, urban, hospital-based general medicine clinics in New York City and New Jersey. Psychological stress was assessed at baseline using the Perceived Stress Scale (PSS), a validated 4-item instrument. Outcomes included the Asthma Control Questionnaire (ACQ), the Asthma Quality of Life Questionnaire (AQLQ), and the Medication Adherence Reporting Scale (MARS) measured at baseline, 1, 3, and 12 months of enrollment. Results. Higher perceived stress was significantly correlated with worse asthma control (ACQ scores; r = .30 to .37, p < .0001), poor quality of life (AQLQ scores; r = -.49 to - .35, p < .0001), and decreased medication adherence (MARS scores; r = -.25 to -.15, p < .028) at baseline and across the follow-up interviews. In multivariate analyses, increased stress remained a significant predictor of worse ACQ (p < .0001), AQLQ scores (p < .0001), and MARS (p < .0001) after adjusting for age, sex, income, number of years with asthma, and comorbidities. Conclusions. Among inner-city asthmatics, higher perceived stress is strongly associated with increased asthma morbidity across a 1-year follow-up. Further research is needed to identify mechanisms mediating the association between stress and asthma morbidity in adults.Journal of Asthma 02/2010; 47(1):100-4. DOI:10.3109/02770900903426989 · 1.83 Impact Factor
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ABSTRACT: Complementary and alternative medicines (CAM), such as herbal remedies, are widely used by patients with chronic diseases, such as asthma. However, it is unclear whether use of the herbal remedies is associated with decreased adherence to inhaled corticosteroids (ICSs), a key component of asthma management. To examine the association among use of herbal remedies, adherence to prescribed ICSs, and medication and disease beliefs. We surveyed 326 adults with persistent asthma who received care at 2 inner-city outpatient clinics. Patients were asked about CAM use (teas, herbs, and rubs) for the treatment of asthma in the prior 6 months. Medication adherence was assessed using the Medication Adherence Report Scale, a validated self-report measure. Univariate and multiple regression analyses were used to assess the relationship among herbal remedy use, adherence to ICSs, and medication and disease beliefs. Overall, 25.4% (95% confidence interval, 20%-30%) of patients reported herbal remedy use. Univariate analyses showed that herbal remedy use was associated with decreased ICS adherence and increased asthma morbidity. In multivariable analysis, herbal remedy use was associated with lower ICS adherence (odds ratio, 0.4; 95% confidence interval, 0.2-0.8) after adjusting for confounders. Herbal remedy users were also more likely to worry about the adverse effects of ICSs (P = .01). The use of herbal remedies was associated with lower adherence to ICSs and worse outcomes among inner-city asthmatic patients. Medication beliefs, such as worry about ICS adverse effects, may in part mediate this relationship. Physicians should routinely ask patients with asthma about CAM use, especially those whose asthma is poorly controlled.Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 02/2010; 104(2):132-8. DOI:10.1016/j.anai.2009.11.024 · 2.75 Impact Factor
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ABSTRACT: The GA(2)LEN taskforce on Patient-Reported Outcomes (PROs) and Health-Related Quality of Life (HRQoL) published in 2009 a position paper concerning PROS and HRQoL assessment in clinical trials on allergy. Because of the specificity of this topic in asthma and rhinitis, specific recommendations are needed. The aim of this position paper is to define PROs and their meaning in asthma and rhinitis research, explore the available tools to provide criteria for a proper choice, identify patient-related factor which could influence PROs assessment, define specific recommendations for assessment, analysis and results spreading, underline the unexplored areas and unmet needs. PROs assessment is gaining increasing importance, and it must be performed with a rigorous methodological procedure and using validated tools. This approach enables to better understand patient-related factors influencing clinical trials and real-life management outcomes, identify patients subgroups that can benefit from specific treatment and management plan and tailor treatment to address PROs (not only physician-defined targets) to improve asthma and rhinitis management.Allergy 08/2010; 65(8):959-68. DOI:10.1111/j.1398-9995.2010.02383.x · 6.00 Impact Factor