The Scale of Quantitative Assessment Adherence to Treatment «QAA-25»: Updating of Formulations, Constructive and Factor Validity and a Measure of Consent

Aim: To update the definitions of selected questions of the "QAA-25" (quantitative adherence assessment) scale and evaluate it according to the criteria of validity and measure of agreement.Materials and Methods. In a descriptive cross-sectional study including 200 patients with coronary heart disease, adherence was determined using traditional and alternative versions of selected questions of the QAA-25 scale, followed by assessment of construct validity, factor validity, and measure of agreement.Results. Alternative question versions did not significantly affect test results, with 81% of respondents in the outpatient sample and 69% in the inpatient sample rating them as "more acceptable." The QAA-25 scale has good construct and internal validity (α – 0.818, αst – 0.832), with moderate agreement (κ – 0.562) and demonstrates high reliability of internal validity – when scale items are consistently excluded, α values remain in the 0.801-0.839 range.Conclusion. The QAA-25 scale with modified question definitions should be used instead of the previous version of the scale. Good construct validity and factor validity, sufficient measure of agreement and specificity, high sensitivity and reliability of the QAA-25 scale allow to recommend it as a tool for assessing adherence to drug therapy, medical support, lifestyle modification and integral adherence to treatment in scientific and clinical practice.

Children’s Adherence to Antiretroviral Therapy and Associated Factors: Multi-center Cross-sectional Study

Background- Sub- optimal adherence to antiretroviral therapy will lead drug resistance, treatment failure, clinical deterioration, death and failure to thrive in children. Studies conducted among children below 15 years old were limited in Ethiopia in general and in study area in particular. Therefore, this study was aimed to assess status of children’s adherence to ART and associated factors in study area. Methods- We conduct a facility-based cross-sectional study by including total of 282 children <15 years, who received Anti retro viral therapy for at least one month. All children/caregivers who were attending ART clinic during data collection period were consecutively recruited to the study. Both bivariate and multivariate logistic regression were performed. Result- Out of 282 caregivers included with their children, 226(80.2%) were females (mean age= 38.6 and SD = 12.35) and out of the total children, half (50%) were female and 246(87.2%) were between the ages 5–14 years (mean age= 8.5 and SD = 2.64). Two hundred forty six (87.2%) children had adherence status of ≥95% in the month prior to interview. Children whose caregivers were residing in urban were 3.3 (95% CI: 1.17, 9.63) times more adherent to ART than those whose caregivers were residing in rural. Children whose caregivers were biological parent were 2.37(95% CI: 1.59, 3.3) times more adherent than those whose caregivers were non biological parent. Also children of caregivers who were knowledgeable about ART treatment, were 4.5(95% CI: 1.79, 9.8) times more adherent to ART than their counter partsConclusion and recommendation- Adherence status of children in our study area was comparable. Being biological caregivers, residing in urban and knowledgeable about ART treatment were facilitate adherence to ART. Ongoing education about treatment and further study with multiple adherence assessment method were recommended.

Timetable and Headway Adherence Assessment using the Gini Coefficient and the Lorenz Curve

Adherence to the schedule is of prime importance in public transport. This paper presents a specific application of the Gini coefficient, well known indicator in economics, for the headway adherence assessment. The paper shows that Lorenz curve, which is usually used to define mathematically the Gini coefficient, is a good indicator of the users' waiting time when it is based on the bus schedule. When it is computed on the basis of the ratio of observed headway to the schedule, it is a powerful visual tool that can be used by operators to detect the existence of irregularities on a bus line at a glance. An equation gives, in an idealistic case, the impact of any single traffic disturbance on the Gini coefficient, making this coefficient comprehensive. A detailed analysis is developed, based on the bus proportions according to the headway adherence level. These proportions are obtained from new indices coming from the derivative of the Lorenz curve. The values of these indexes alert the operator of any adherence disturbance. The examination of the Lorenz curve takes more time, but is worthwhile, giving the types of the irregularities The application of these indicators is carried on real-time data from the New Delhi bus network.

Open Issues and Practical Suggestions for Telemedicine in Chronic Pain

Telemedicine represents a major opportunity to facilitate continued assistance for patients with chronic pain and improve their access to care. Preliminary data show that an improvement can be expected of the monitoring, treatment adherence, assessment of treatment effect including the emotional distress associated with pain. Moreover, this approach seems to be convenient and cost-effective, and particularly suitable for personalized treatment. Nevertheless, several open issues must be highlighted such as identification of assessment tools, implementation of monitoring instruments, and ability to evaluate personal needs and expectations. Open questions exist, such as how to evaluate the need for medical intervention and interventional procedures, and how to define when a clinical examination is required for certain conditions. In this context, it is necessary to establish dynamic protocols that provide the right balance between face-to-face visits and telemedicine. Useful tips are provided to start an efficient experience. More data are needed to develop precise operating procedures. In the meantime, the first experiences from such settings can pave the way to initiate effective care pathways in chronic pain.

A systematic literature review of existing tools used to assess medication adherence in connective tissue diseases: the state of the art for the future development of co-designed measurement tools

Lack of medication adherence is frequent in chronic connective tissue diseases and is associated with poorer health outcomes, low quality of life and economic loss. This research is based on a systematic literature search and aims to identify the surveys and tools used for the assessment of medication adherence in patients with connective tissue diseases (CTDs) and in particular the tools co-designed with patients. A systematic literature review was performed in PubMed and Embase databases searching for studies concerning the application of surveys or tools designed for medication adherence assessment. A specific analysis was also performed to identify which of these existing tools were developed in co-design with patients affected by CTDs. 1958 references were identified, and 31 studies were finally included. Systemic lupus erythematosus was the most investigated disease, followed by the Behçet’s disease. The tools used to assess adherence in CTDs were, in most cases, valid and useful. However, the results showed a certain degree of heterogeneity among the studies and the medication adherence assessment and measurement tools adopted, which were mostly based on selfreported questionnaire. No co-designed tools with patients were found. Low- and non-adherence were explored in some CTDs with valid and useful tools, while other CTDs still need to be assessed. Therefore, more efforts should be made to better understand the specific reasons for the low- and non-adherence in CTDs patients.

Potential adherence to treatment in gastroenterological patients

Objective. To assess the level of potential adherence to treatment in patients with gastrointestinal syndromes.Material and Methods. The open-label, cross- sectional study included 264 respondents who underwent preventive examinations. To identify gastroenterological syndromes we used Gastrointestinal Simptom Rating Scale (GSRS) questionnaire, which allows assessing the presence and the intensity of diarrheal, dyspeptic, constipation, refl ux syndrome and abdominal pain syndrome. The study group includes respondents who, according to the results of the GSRS questionnaire, have at least one syndrome (from 2 or more points) (N = 140). The comparison group included participants without gastrointestinal syndromes (N = 124). The level of adherence was assessed using the Quantitative Adherence Assessment Questionnaire (QAA-25). A score of less than 50% corresponds to a low level of adherence; a score between 50% and 75% corresponds to a medium level of adherence. Of 75% and above is considered to be a high and suffi cient level of adherence in the respondent.Results. Absolutely all respondents demonstrated an insuffi cient level of adherence to both drug therapy and medical support and lifestyle modifi cations. One in ten study participants had an medium level of adherence. The other 90% of patients from all groups had a low level of compliance (less than 50%) in all three areas of treatment adherence.Conclusions. Participants in our study were potentially unprepared for adherence to treatment that is consistent with optimal protocols. This demonstrates the need to work with adherence, both using ways to increase adherence and using patientcentered approaches that take into account the individual level of adherence.

Study of the Quality of Medical Therapy and Adherence in Patients with Chronic Heart Failure (According to the COMPLIANCE Study)

Aim. Assess the medical therapy quality in patients with chronic heart failure (CHF) and patients' adherence to the treatment depending on the previous observation in a specialized medical center as part of an of an outpatient registry.Materials and methods. An analysis of the medical therapy quality in patients with CHF was carried out as part of the COMPLIANCE prospective observational study (NCT04262583). 72 patients with CHF verified according to the protocol were included in the study. The average age of the patients was 69.1±9.5 years (31% of women and 69% of men). Patients were divided into groups: those who first applied to a specialized department during the period of the study inclusion, or those who were previously observed in a specialized department. The general adherence assessment to medical therapy was carried out using the original questionnaire «The adherence scale of the National Society for Evidence-Based Pharmacotherapy» which was supplemented with questions to assess the actual adherence to specific medical drugs recommended for patients with CHF.Results. According to the results of the study, beta-blockers were prescribed to 70 (97.2%) patients. Angiotensin converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs) were recommended in 68 (94%) patients. Mineralocorticoid receptor antagonists were included in therapy in 6 out of 9 patients who were shown to be prescribed (66.6%). The choice of medical drugs within the group was not always adequate. For example, ACEi/ARBs with proven efficacy in patients with CHF were prescribed only in 72% of patients. Comparative analysis of adherence to medical therapy between patients of the selected groups demonstrated a higher adherence to the recommended therapy in patients who were previously observed in a specialized center.Conclusion. The medical therapy quality for patients with CHF doesn't always comply with current clinical guidelines. The choice of a medical drug within a group is not always adequate. Regular observation in a specialized center contributes to a higher adherence to the recommended therapy.

Validation of an Arabic Version of the Adherence to Refills and Medications Scale (ARMS)

Background: Medication non-adherence is a complex multifactorial phenomenon impacting patients with various health conditions worldwide. Therefore, its detection can improve patient outcomes and minimize the risk of adverse consequences. Even though multiple self-reported medication adherence assessment scales are available, very few of them exist in Arabic language. Therefore, the aim of this study was to validate a newly translated Arabic version of the Adherence to Refills and Medications Scale (ARMS) among patients with chronic health conditions. Methods: This is a single-center cross-sectional study that was conducted between October 10th 2018 and March 23rd 2021. ARMS was first translated to Arabic using the forward-backward translation method. The translated scale was then piloted among 21 patients with chronic health conditions (e.g., diabetes, hypertension, etc.…) to examine its reliability and comprehensibility using the test-retest method. Thereafter, the Arabic-translated ARMS was self-administered to adult patients aged ≥18 years with chronic health conditions visiting the primary care clinics of a university-affiliated tertiary care hospital in Riyadh, Saudi Arabia. Construct validity was examined using factor analysis with varimax rotation. Results: Of the 264 patients who were invited to participate, 202 (76.5%) consented and completed the questionnaire. Most of the participants were males (69.9%), married (75.2%), having a college degree or higher (50.9%), retired or unemployed (65.2%), aged ≥ 50 years (65.2%), and are diabetic (95.9%). The 12-item Arabic-translated ARMS mean score was 17.93 ± 4.90, and the scale yielded good internal consistency (Cronbach’s alpha = 0.802) and test-retest reliability (Intraclass correlation coefficient = 0.97). Two factors were extracted explaining 100% of the of the total variance (factor 1 = 52.94% and factor 2 = 47.06%). Conclusions: The 12-item Arabic version of ARMS demonstrated good validity and reliability. Therefore, it should help in the detection of medication non-adherence among Arabic-speaking patient population and minimize the risk of adverse consequences.