Questionnaires and scores for assessing medication adherence — advantages and disadvantages of the diagnostic method in research and actual clinical practice

The problem of medication adherence is still relevant, and the search for a reliable method for its diagnosis continues. One of the most convenient and promising ways to assess medication adherence, both in research and actual clinical practice, is the use of various questionnaires and scores. Currently, several dozen different questionnaires and scores are presented in Russia and other countries. All of them are indirect methods of adherence assessment and are characterized by subjectivity. The article presents data on the most famous and widely used foreign adherence scales (the 4- and 8-item Morisky Medication Adherence Scale (MMAS-4 and MMAS-8), Hill-Bone, SEAMS, BMQ, MARS, etc.) and several questionnaires proposed by Russian authors (the National Society of Evidence-based Pharmacotherapy Adherence Scale, the Quantitative Adherence Questionnaire and the National Questionnaire of Treatment Compliance). The main characteristics of the described scales, their advantages, disadvantages and prospects for use in studies and clinical practice are considered. There are following conclusions: 1) none of the current questionnaires is devoid of subjectivity; 2) almost all questionnaires overestimate medication adherence, do not fully diagnose nonadherence, and often determine only specific type of adherence; 3) even validated questionnaires, which used in patients with different diseases in various countries, can have different values of sensitivity, specificity and reliability — from excellent to very poor; 4) in this regard, the results should be skeptically and cautiously interpreted; 5) in actual clinical practice, preference should be given to concise scales that include no more than 10 questions, with a  simple scoring system, preferably validated with using well-known criteria from large clinical trials; 6) to improve the diagnosis accuracy, usage of several available methods for assessing medication adherence is recommended.

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