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Accuracy of the Medication Adherence Report Scale (MARS-5) as a quantitative measure of adherence to inhalation medication in patients with COPD

Eline Tommelein (UGent) , Els Mehuys (UGent) , Inge Van Tongelen (UGent) , Guy Brusselle (UGent) and Koen Boussery (UGent)
(2014) ANNALS OF PHARMACOTHERAPY. 48(5). p.589-595
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Abstract
Background: Self-report is considered most suitable to measure medication adherence in routine clinical practice. However, accuracy of self-report as a quantitative measure of adherence is not well documented. Objective: To assess the accuracy of a self-report measure of adherence (Medication Adherence Report Scale [MARS-5]) for identifying nonadherent users of inhalation medication among patients with chronic obstructive pulmonary disease (COPD), compared with medication refill adherence (MRA) as reference. Methods: We used baseline data from the Pharmaceutical Care for Patients with COPD (PHARMACOP)-trial (n = 734). Patients with incomplete MARS-5 and/or incomplete pharmacy refill records were excluded (n = 121). Internal consistency of MARS-5 (Crohnbach α) and Spearman rank correlation (ρ) with MRA were calculated. Different thresholds for nonadherence were used to calculate sensitivity, specificity, and positive predictive value (PPV), compared with dichotomized MRA (MRA ≥80% = adherent). A receiver operating characteristic (ROC) curve was plotted to determine the goodness of test. Results: 613 patients were included in the analysis. The mean adherence score by MARS-5 (range = 5-25) was 23.5 (SD = 2.6); mean adherence by MRA was 83.4% (SD = 23.8%). Internal consistency of MARS-5 was high (α = 0.77). Continuous MARS-5 scores correlated poorly with continuous MRA scores (ρ = 0.10; P = 0.011). When lowering the nonadherence threshold stepwise from 25 to 20, MARS-5 did not reach sufficient sensitivity (53% to 13%), specificity (57% to 94%), and PPV (42% to 57%) to detect nonadherers compared with dichotomized MRA. ROC curve plotting resulted in an area under the curve value of 0.56 (95% CI = 0.521-0.616; P = 0.005). Conclusion: Self-reported adherence measured by MARS-5 is inaccurate in identifying nonadherence to inhalation medication in patients with COPD.
Keywords
inhalation medication, MRA, MARS, COPD, adherence, OBSTRUCTIVE PULMONARY-DISEASE, SELF-REPORT, INHALED CORTICOSTEROIDS, PHARMACY RECORDS, REFILL ADHERENCE, NONADHERENCE, VALIDITY, THERAPY, DRUGS, CARE

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MLA
Tommelein, Eline, Els Mehuys, Inge Van Tongelen, et al. “Accuracy of the Medication Adherence Report Scale (MARS-5) as a Quantitative Measure of Adherence to Inhalation Medication in Patients with COPD.” ANNALS OF PHARMACOTHERAPY 48.5 (2014): 589–595. Print.
APA
Tommelein, E., Mehuys, E., Van Tongelen, I., Brusselle, G., & Boussery, K. (2014). Accuracy of the Medication Adherence Report Scale (MARS-5) as a quantitative measure of adherence to inhalation medication in patients with COPD. ANNALS OF PHARMACOTHERAPY, 48(5), 589–595.
Chicago author-date
Tommelein, Eline, Els Mehuys, Inge Van Tongelen, Guy Brusselle, and Koen Boussery. 2014. “Accuracy of the Medication Adherence Report Scale (MARS-5) as a Quantitative Measure of Adherence to Inhalation Medication in Patients with COPD.” Annals of Pharmacotherapy 48 (5): 589–595.
Chicago author-date (all authors)
Tommelein, Eline, Els Mehuys, Inge Van Tongelen, Guy Brusselle, and Koen Boussery. 2014. “Accuracy of the Medication Adherence Report Scale (MARS-5) as a Quantitative Measure of Adherence to Inhalation Medication in Patients with COPD.” Annals of Pharmacotherapy 48 (5): 589–595.
Vancouver
1.
Tommelein E, Mehuys E, Van Tongelen I, Brusselle G, Boussery K. Accuracy of the Medication Adherence Report Scale (MARS-5) as a quantitative measure of adherence to inhalation medication in patients with COPD. ANNALS OF PHARMACOTHERAPY. 2014;48(5):589–95.
IEEE
[1]
E. Tommelein, E. Mehuys, I. Van Tongelen, G. Brusselle, and K. Boussery, “Accuracy of the Medication Adherence Report Scale (MARS-5) as a quantitative measure of adherence to inhalation medication in patients with COPD,” ANNALS OF PHARMACOTHERAPY, vol. 48, no. 5, pp. 589–595, 2014.
@article{4362435,
  abstract     = {Background: Self-report is considered most suitable to measure medication adherence in routine clinical practice. However, accuracy of self-report as a quantitative measure of adherence is not well documented.
Objective: To assess the accuracy of a self-report measure of adherence (Medication Adherence Report Scale [MARS-5]) for identifying nonadherent users of inhalation medication among patients with chronic obstructive pulmonary disease (COPD), compared with medication refill adherence (MRA) as reference.
Methods: We used baseline data from the Pharmaceutical Care for Patients with COPD (PHARMACOP)-trial (n = 734). Patients with incomplete MARS-5 and/or incomplete pharmacy refill records were excluded (n = 121). Internal consistency of MARS-5 (Crohnbach α) and Spearman rank correlation (ρ) with MRA were calculated. Different thresholds for nonadherence were used to calculate sensitivity, specificity, and positive predictive value (PPV), compared with dichotomized MRA (MRA ≥80% = adherent). A receiver operating characteristic (ROC) curve was plotted to determine the goodness of test.
Results: 613 patients were included in the analysis. The mean adherence score by MARS-5 (range = 5-25) was 23.5 (SD = 2.6); mean adherence by MRA was 83.4% (SD = 23.8%). Internal consistency of MARS-5 was high (α = 0.77). Continuous MARS-5 scores correlated poorly with continuous MRA scores (ρ = 0.10; P = 0.011). When lowering the nonadherence threshold stepwise from 25 to 20, MARS-5 did not reach sufficient sensitivity (53% to 13%), specificity (57% to 94%), and PPV (42% to 57%) to detect nonadherers compared with dichotomized MRA. ROC curve plotting resulted in an area under the curve value of 0.56 (95% CI = 0.521-0.616; P = 0.005).
Conclusion: Self-reported adherence measured by MARS-5 is inaccurate in identifying nonadherence to inhalation medication in patients with COPD.},
  author       = {Tommelein, Eline and Mehuys, Els and Van Tongelen, Inge and Brusselle, Guy and Boussery, Koen},
  issn         = {1060-0280},
  journal      = {ANNALS OF PHARMACOTHERAPY},
  keywords     = {inhalation medication,MRA,MARS,COPD,adherence,OBSTRUCTIVE PULMONARY-DISEASE,SELF-REPORT,INHALED CORTICOSTEROIDS,PHARMACY RECORDS,REFILL ADHERENCE,NONADHERENCE,VALIDITY,THERAPY,DRUGS,CARE},
  language     = {eng},
  number       = {5},
  pages        = {589--595},
  title        = {Accuracy of the Medication Adherence Report Scale (MARS-5) as a quantitative measure of adherence to inhalation medication in patients with COPD},
  url          = {http://dx.doi.org/10.1177/1060028014522982},
  volume       = {48},
  year         = {2014},
}

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