NO001 Application of a Japanese version of the morisky medication adherence scale and related factors to low medication adherence in patient with Ulcerative Colitis
A. Kawakami*1, M. Tanaka2, N. Yamamoto-Mitani3, N. Yoshimura4, R. Suzuki5, S. Maeda6, R. Kunisaki1
1Yokohama City University Medical Centre, Inflammatory Bowel Disease Centre, Yokohama, Japan, 2Mahidol University, Faculty of Medicine Ramatibodi Hospital, Ramatibodi School of Nursing, Bangkok, Thailand, 3The University of Tokyo, School of Health Sciences and Nursing, Tokyo, Japan, 4Social Insurance Central General Hospital, Inflammatory Bowel Disease Centre, Tokyo, Japan, 5Kannai Suzuki Clinic, Division of Gastroenterology, Yokohama, Japan, 6Yokohama City University Graduate School of Medicine, Department of Gastroenterology, Yokohama, Japan
Background
Non-adherence to medication taking behaviour among patients with ulcerative colitis (UC) has been reported 30-45% and can be a serious risk factor for disease relapse. The Morisky Medication Adherence Scale (MMAS-8) is a relevant approach for evaluating medication adherence in a clinical setting. We were interested to evaluate the clinical relevance of a Japanese MMAS-8 version, and the related factors when applied to low adherence among UC outpatients.
Methods
A multicenter, cross-sectional study was undertaken in outpatients with UC who had taken aminosalicylates. The patients completed a self-administered questionnaire, and the medical information was obtained from the medical records. To concurrent validity of the MMAS-8, kappa coefficient between the low adherence in the MMAS-8 (less than 6 points) and low adherence calculated from self-reported missed dose, defined as taking less than an 80% of the prescribed dose was computed. Scale discrimination validity was tested by known group comparisons to assess whether the scale score could discriminate subgroups of patients differing in clinical status, like with or without concomitant UC induction therapy. Internal consistency of the multi-item scale was assessed by the Cronbach's alpha coefficient. Then, logistic regression model was applied to assess the relationships between low-adherence in MMAS-8 and other factors including disease factors, medication characteristics, abdominal symptoms, and socio-demographics characteristics.
Results
Of 429 UC patients, MMAS-8 identified 245 (57.4%) as low adherents to aminosalicylates. The patients without concomitant UC induction therapy showed significantly higher MMAS-8 scores vs the patients with induction therapy. Cronbach's alpha was 0.74, meaning the internal consistency was confirmed to a certain extent. The kappa coefficient for low-adherence in MMAS-8 and self-reported missed dose was 0.4, suggesting concurrent test was moderate. Multiple logistic regression analyses showed that patients with low adherence had difficulties in taking aminosalicylates (OR = 1.12, 95% CI = 1.10-1.17), rectum in disease region (OR = 1.73, 95% CI = 1.10-3.09), less than 5 years UC duration (OR = 2.20, 95% CI = 1.32-3.66) and younger age (OR = 0.95, 95% CI = 0.93-0.97).
Conclusion
The Japanese version of the MMAS-8 was found to be clinically relevant measure and can be used to evaluate medication adherence of UC patients. We also found additional significant factors defining low-adherence. Our findings suggest that patients who have difficulties in taking aminosalicylates should be provided with tailored support. Moreover, development of an effective medication taking behavior program appears to be a serious challenge for the health care providers.