Ladova Katerina, Matoulkova Petra, Zadak Zdenek, Macek Karel, Vyroubal Pavel, Vlcek Jiri, Morisky Donald E
Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Kralove, Hradec Kralove, Czech Republic.
J Eval Clin Pract. 2014 Oct;20(5):671-7. doi: 10.1111/jep.12201. Epub 2014 Jun 11.
RATIONALE, AIMS AND OBJECTIVES: Measuring self-reported adherence may contribute to minimizing the risk of therapy failure. Hence, the main aim of the study was to assess the psychometric properties of the Czech version of Medication Adherence Report Scale (MARS-CZ) and its appropriateness for use in long-term statin therapy where goal levels of low-density lipoprotein cholesterol (LDL-c) should be achieved.
Anonymous structured interview was performed to determine self-reported adherence by MARS-CZ in outpatients chronically treated with statins. At the same time, medication records were reviewed for inclusion of patients into groups of those who achieved and do not achieved LDL-c goal according to cardiovascular risk level. Reliability and validity of MARS-CZ were tested as well as the relationship between adherence and LDL-c goal achievement was examined.
A total of 136 (86.6%) patients completed the interview; mean age was 66.1 years; 49.3% were male. The mean score of MARS-CZ was 24.4 and showed positive skewing. Satisfactory internal consistency (Cronbach's α=0.54), strong test-retest reliability (r=0.83, P<0.001; intra-class correlation=0.63, 95% confidence interval: 0.35-0.81) and positive correlation with eight-item Morisky Medication Adherence Scale (r=0.62, P<0.001) were indicated. Low validity values were found between MARS-CZ and 12-item Short Form Health Survey mental and physical subscales. MARS-CZ score significantly correlated with LDL-c goal achievement (P<0.05) when all patients who achieved LDL-c goal (35%) reported high adherence to statin. MARS-CZ score also correlated with cardiovascular risk level and doctor's judgments on adjusting treatment targets for each patient.
This study proved MARS-CZ as an acceptable self-reported adherence measure. In routine clinical practice, MARS-CZ could be helpful to reveal medication non-adherence before the alteration of drug regimen and thereby contributing to enhancement of statin therapy management.
原理、目的和目标：测量自我报告的依从性可能有助于将治疗失败的风险降至最低。因此，本研究的主要目的是评估捷克版药物依从性报告量表（MARS-CZ）的心理测量特性，以及其在长期他汀类药物治疗中使用的适用性，在该治疗中应达到低密度脂蛋白胆固醇（LDL-c）的目标水平。
对长期接受他汀类药物治疗的门诊患者进行匿名结构化访谈，以通过MARS-CZ确定自我报告的依从性。同时，根据心血管风险水平审查用药记录，将患者纳入达到和未达到LDL-c目标的组。测试了MARS-CZ的信度和效度，并检查了依从性与LDL-c目标达成之间的关系。
共有136名（86.6%）患者完成了访谈；平均年龄为66.1岁；49.3%为男性。MARS-CZ的平均得分为24.4，呈正偏态分布。显示出令人满意的内部一致性（Cronbach'sα=0.54）、较强的重测信度（r=0.83，P<0.001；组内相关系数=0.63，95%置信区间：0.35-0.81）以及与八项Morisky药物依从性量表呈正相关（r=0.62，P<0.001）。在MARS-CZ与12项简短健康调查问卷的心理和身体子量表之间发现了较低的效度值。当所有达到LDL-c目标的患者（35%）报告对他汀类药物的高依从性时，MARS-CZ得分与LDL-c目标达成显著相关（P<0.05）。MARS-CZ得分还与心血管风险水平以及医生对每位患者调整治疗目标的判断相关。
本研究证明MARS-CZ是一种可接受的自我报告依从性测量方法。在常规临床实践中，MARS-CZ有助于在改变药物治疗方案之前发现药物不依从情况，从而有助于加强他汀类药物治疗管理。
