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Factors associated with false-positive self-reported adherence to antihypertensive drugs

Journal of Human Hypertension volume 31, pages 320–326 (2017)Cite this article

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Abstract

Self-reported medication adherence is known to overestimate true adherence. However, little is known about patient factors that may contribute to the upward bias in self-reported medication adherence. The objective of this study is to examine whether demographic, behavioral, medication and mood factors are associated with being a false-positive self-reported adherer (FPA) to antihypertensive drug treatment. We studied 175 patients (mean age: 50 years; 57% men) from primary-care clinics starting antihypertensive drug treatment. Self-reported adherence (SRA) was measured with the Medication Adherence Report Scale (MARS) and by the number of drug doses missed in the previous week/month, and compared with pill count adherence ratio (PCAR) as gold standard. Data on adherence, demographic, behavioral, medication and mood factors were collected at baseline and every 3 months up to 1 year. FPA was defined as being a non-adherer by PCAR and an adherer by self-report. Mixed effect logistic regression was used for the analysis. Twenty percent of participants were FPA. Anxiety increased (odds ratio (OR): 3.00; P=0.01), whereas smoking (OR: 0.40; P=0.03) and drug side effects (OR: 0.46, P=0.03) decreased the probability for FPA by MARS. Education below high-school completion increased the probability of being an FPA as measured by missing doses in the last month (OR: 1.66; P=0.04) and last week (OR: 1.88; P=0.02). The validity of SRA varies significantly according to drug side effects, behavioral factors and patient’s mood. Careful consideration should be given to the use of self-reported measures of adherence among patients likely to be false-positive adherers.

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Acknowledgements

This study was conducted at the Department of Population Health Sciences, University of Wisconsin–Madison. This study was funded by the American Heart Association, Award Number MSN101929 and by the University of Wisconsin Institute for Clinical and Translational Research (NIH Clinical and Translational Science Award, Award Number 1 UL1 RR025011). This study was approved by the Institutional Review Board of the University of Wisconsin (UW)–Madison

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Authors and Affiliations

  1. Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Y G Tedla

  2. Department of Population Health Sciences, University of Wisconsin at Madison, Madison, WI, USA

    L E Bautista

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Correspondence to Y G Tedla.

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Tedla, Y., Bautista, L. Factors associated with false-positive self-reported adherence to antihypertensive drugs. J Hum Hypertens 31, 320–326 (2017). https://doi.org/10.1038/jhh.2016.80

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