Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA.
Inflamm Bowel Dis. 2011 Feb;17(2):599-604. doi: 10.1002/ibd.21310.
To date no adherence survey has been validated in IBD. The aim was to administer an improved medication adherence survey to IBD patients, to validate the scale in IBD, and to compare the results to perceived adherence by the gastroenterologists.
IBD patients were given the Morisky Medication Adherence Scale (MMAS-8). To validate the scale, prescription claim information, calculated as continuous single-interval medication availability (CSA) and mean possession ratio (MPR), was correlated to the MMAS-8 scale. Nonpersistence or low adherence was defined as a CSA or MPR<0.8. Treating gastroenterologists, blinded to the instrument, then assessed adherence in these patients.
Of 110 IBD patients in the study, MMAS-8 identified 54 patients as low adherers (LAs) to their IBD medication and 56 patients as medium or high adherers (MHAs). Eighty-five percent of LAs had nonpersistent fill rates, as per CSA, compared with 11% of MHAs. Physicians correctly classified 95% of patients who were MHAs but only 33% of LAs. Underestimation of adherence only occurred in 5% of patients, whereas overestimation occurred in 67% (P<0.0001). In a linear regression analysis, CSA was significantly correlated with disease activity score (P<0.001).
LAs are a challenge to identify. This study demonstrates that the MMAS-8 scale is a valid instrument for assessing medication adherence in IBD. This is the first adherence scale to be validated in IBD.
迄今为止，尚未有针对 IBD 的依从性调查得到验证。本研究旨在对 IBD 患者进行改良后的药物依从性调查，并验证该量表在 IBD 中的适用性，同时将结果与胃肠病医生对患者的依从性感知进行比较。
IBD 患者接受 Morisky 药物依从性量表（MMAS-8）调查。为验证该量表的适用性，将处方用药信息（计算为连续单一间隔药物可及性（CSA）和平均占有比（MPR））与 MMAS-8 量表进行相关性分析。非持续或低依从性定义为 CSA 或 MPR<0.8。对这些患者，接受治疗的胃肠病医生在不了解该工具的情况下对其进行评估。
在这项研究的 110 例 IBD 患者中，MMAS-8 确定 54 例患者为 IBD 药物低依从者（LAs），56 例患者为中或高依从者（MHAs）。根据 CSA，85%的 LAs 持续用药填充率不高，而 11%的 MHAs 持续用药填充率高。医生正确分类了 95%的 MHAs 患者，但仅正确分类了 33%的 LAs 患者。仅 5%的患者出现依从性低估，而 67%的患者出现高估（P<0.0001）。在线性回归分析中，CSA 与疾病活动评分显著相关（P<0.001）。
LAs 很难识别。本研究表明，MMAS-8 量表是评估 IBD 患者药物依从性的有效工具。这是第一个在 IBD 中得到验证的依从性量表。
