Did the clinical trial use the Morisky? The Morisky Medication Adherence Scale is a simple and effective tool to address medication non-adherence in clinical trials. With an Internal Consistency
Cronbach's alpha .83, Sensitivity 93%, and Specificity 57%. It has been validated by clinicians and health professionals for different chronic conditions. It has been translated in over 90 languages. It can be administered electronically or at each office visit for long-term consistent evaluation.
The MMAS-8 has undergone numerous levels of validation, including construct validation, discriminant validation, convergent validity with the MMAS scales, and the closest type of validation which mimics the "gold standard", criterion-related validity. The self-reported MMAS-8 agreed with physiological outcome measures such as BP control, HgA1c levels, GFR rates, HDL/LDL ratios, viral load levels, topical skin disorders, etc.
This question addresses unintentional medication non-adherence. Unintentional medication non-adherence is a passive process in which the patient does not adhere to how the medication is prescribed because of several domains of non-adherence such as they forget, don’t understand, or because of poor health literacy.
As a healthcare provider you can tailor your counseling when you understand why the patient is forgetting to take their medication. The MMAS-8 scale is not only used for measuring the magnitude of non-adherence but also provides a diagnostic assessment as to why the patient is non-adherent so health care providers can tailor educational counseling sessions and motivational interviewing questions to improve their medication taking behavior.
Adherence refers to the extent patient behavior matches advice from health care providers. Non-adherence should not be a reason to blame the patient
The reason why the Morisky scales are highly validated is because of the way the questions are phrased to avoid “yes saying” bias. The MMAS-8 was conceptualized to reduce victim blaming by reversing the direction of the question. The MMAS-8 never asks the patient "Do you always take your high blood pressure medication" because 90% of my patients will say "yes, doctor" because they don’t want to be blamed for not taking their medication. So, we ask in the negative direction, "Do you sometimes forget to take your high blood pressure medication"? Now about 50% will respond "yes".
Intentional non-adherence is one of the major reasons why patients do not reach their therapeutic goals.
The Morisky Scales consist of two subscales, unintentional and intentional non-adherence, that are coded as four dichotomous (yes/no) variables in the MMAS-4 and seven dichotomous variables with a 5-point Likert scale in the MMAS-8.
Intentional medication non-adherence is an active decision from the patient to take their medication as prescribed. This is a process in which a patient makes a rational decision based on the benefits of medication adherence compared to risks of medication non-adherence.
Unintentional medication non-adherence is a passive process in which the patient does not adhere to how the medication is prescribed because they forget, don’t understand, or because of poor health literacy.
Many patients suffer from a chronic disease and remembering to take all their medication as prescribed can mean the difference between life and death. The MMAS-8 scale is a power validated diagnostic tool that identifies when polypharmacy is a reason for medication non-adherence.
Did you take all your medication when you were last supposed to?
How often do you have difficulty taking all your medication as prescribed?
The MMAS-8 questions number 5 and 8 provides health care providers the magnitude of polypharmacy non-adherence with an .83 internal consistency and 93% sensitivity.
The Morisky Protocol assesses the differential impact of unintentional (forgetfulness and polypharmacy) and intentional (stopping use of medication if feeling better or worse) medication non-adherence.
Life Insurance companies can reduce heart attacks by using the Morisky Scale to evaluate medication adherence.
Million Hearts® is a national initiative to prevent 1 million heart attacks and strokes within 5 years. Read more how the Morisky Scales are used.
Why is there a question about tobacco use on employee annual healthcare enrollment? Insurance carriers recognize that smokers have higher hospitalization rates.
It only makes sense to ask about medication adherence. Insurance carriers recognize highly adherent employee populations have lower hospital visits and hospital readmissions. The MMAS-4 or MMAS-8 is a validated tool insurance companies, insurance brokers and employers can use to lower employee health care cost.
1. Appointment-Keeping Behavior
Patients who receive educational counseling
3. Behavior Change
4. 30-dauy Hospital Readmissions
5. Morbidity and Mortality
6. Quality of Life
Social Desirability (SD) bias refers to the tendency of research subjects to give socially desirable responses instead of choosing responses that are reflective of their true feelings. The bias in responses due to this personality trait becomes a major issue when the scope of the study involves socially sensitive issues such as politics, personal issues such as drug use, cheating, smoking. and medication-taking. Whenever possible, it is desirable to measure the extent of the bias present in responses to a survey by incorporating a socially desirable scale in the survey. This is particularly a bias when we use indirect methods, such self-reported questionnaires.
The MMAS-8 was conceptualized to reduce the presence of SD by reversing the direction of the question. The MMAS-8 never asks the parient "Do you always take your high blood pressure medication" because 90% of my patients will say "yes, doctor". So, we ask in the negative direction, "Do you sometimes forget to take your high blood pressure medication"? Now about 50% will respond "yes".
When a patient is adherent to their medications but their health condition is out of control this called a false positive. A false positive gives the patient a dangerous illusion that they are in good health. The first step to correcting false positives is to evaluate the dosing for the medications that the patient is taking. Patients often receive new medications or have changes made to their existing medications. Medication reconciliation is the process where medications prescribed by a health care provider are checked to ensure that they match and are current with their prescription.