Medication Adherence Assessment Scale by Mrs. Hajra Patel and Dr. Jitendra Vaghasiya

To overcome medication non-adherence in chronic disorder, A pharmacist can play a very important role by doing patient counselling and this can be done using different scale for medication adherence assessment and focus the particular factor responsible for medication non-adherence.

Adherence has been defined as the “active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of behaviour to produce a therapeutic result. Medication adherence usually refers to whether patients take their medications as prescribed, as well as whether they continue to take a prescribed medication.²

According to WHO, in chronic disorders, medication adherence can be observed up to 50% in developed countries. This is one of the crucial health issues. That is why improving medication non-adherence is very essential.³

In the case of chronic disorders like hypertension, diabetes, tuberculosis, thyroid, rheumatoid arthritis, and COPD (chronic obstructive pulmonary disease), the major concern is medication non-adherence. which compromises the treatment quality, cost effectiveness, cure rate, and patient’s quality of life. To overcome this issue, healthcare professionals can be engaged and the counselling regarding proper medication adherence can be very useful.

For better counselling, first assessment of medication non-adherence and particular factors involved in an individual’s medication non-adherence is required. For that purpose, different medication adherence assessment scales are available. In the adherence assessment scales, a questionnaire is given with respect to different scales. A number of questions are asked to patients, and on the basis of their answers, a score has been given. Factors can be determined based on answers in order to counsel patients. In assessment scale questions, the factor associated with adherence is evident. As a result, a councilor can relate the factors affecting the individual for his/her non-adherence based on a yes or no answer. pharmacist can counsel the patient for adherence and try to satisfy the issues related to medication non-adherence. There are a number of different adherence evaluation scales available, but all scales have their own limitations. There is no gold standard scale available for assessment of adherence.⁴ So to overcome these limitations, one more assessment scale has been developed, which is named as Mrs. Hajra & Dr. Jitendra’s medication adherence assessment scale.

Various factors are responsible for medication non-adherence in chronic disorders which are mentioned in Table 1. This factors are consider to design the questionnaire scale.

Here we can find various factors that are responsible for medication non-adherence as well as the reasons which are mentioned in Table 2, that are commonly observed for not following proper medication. it is also observed that while selecting medication for a patient, the patient’s choices like taste, route of administration, income, educational status, and their medication taking attitude are not priorities. And that is why sometimes non-adherence is encountered. So, to resolve these issues, the practice of patient counselling can be very helpful because the patient’s choices can be either satisfied with proper medication selection or at least the patient can be made to understand the importance of following a proper treatment plan.

These factors suggest a strong requirement for patient counselling in normal clinical practice, which is very widely not observed in normal clinical practice. Also, planning for better counselling can be done and to execute that, some good scales can be used to Figure out specific factors and reasons related to a patient’s medication non-adherence.

One scale has been developed after studying various factors and reasons for non-adherence. This scale includes 09 questions, each mentioned in Table 3 and each question determines different factors. On the basis of yes/no answers, a score will be given. score will set different levels of adherence, for example, high adherence, medium adherence, and low adherence.

This scale has been validated by well-reputed physicians working in different departments related to chronic disorders.

>4 = low adherence.
4-7 = medium adherence.
8-9 = high adherence.

This questionnaire scale is designed by keeping the factors affecting medication non-adherence in mind, mentioned in Table 1 So, by asking certain questions, the pharmacist will Figure out some specific factors that are contributing to medication non-adherence mentioned in Table 4 and, hence, the pharmacist can counsel the patient to overcome such issues. This direct conversation between patient and pharmacist can aid in improving medication adherence in chronic diseases.

In MMAS8 many limitations were found, as most of questions are related to forgetfulness. Example: question 5 (if you take all your medicines yesterday?) has answer ‘NO’ then automatically question 1(do you sometimes forget to take your medications?) and 8 (how often do you have difficulty remembering to take all your medicines?) will be also showed score, so total score will be 3 with only 1 answer.

Similarly, if question 4 (when you travel or leave home, do sometimes forget to bring along your medication?) will be yes automatically 1 and 8 will give score this shows same alike questions and can be taken as single question.

There are numerous self-report assessments available to gauge medication adherence. There is no ideal scale for assessing adherence due to the variety of chronic conditions. Each of the existing adherence assessment scales has advantages and disadvantages. The Medication Adherence Assessment Scale was created and confirmed by Mrs. Hajra Patel and Dr. Jitendra Vaghasiya in an effort to get over the aforementioned obstacle. This scale has been approved by a doctoral competent team of pharmacists and other expert doctors.Each question on this scale is connected to a separate set of variables. Therefore, based on patient responses, it can be deduced which specific causes are more likely to result in non-adherence in a given patient. Based on this insight, pharmacists can also engage in helpful patient counselling that addresses the concerns and problems that are keeping patients from adhering. Patients’ medication adherence is assessed in the majority of studies, however there are very few studies that provide information on the impact of patient counselling. Therefore, patient counselling and factor assessment can be put into practice after employing this form of questionnaire scale.

Thank you so much to Dr. Rohit at Civil Hospital, Bharuch for all co-operation. and hear warming thank you to Mr. Ezazahmed patel for all his kind support.