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Reliability of a Medication Adherence Measure in an Outpatient Setting

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ABSTRACT

Background

Reliable approaches for measuring antihypertensive medication compliance in the outpatient setting are not readily available. The objective of the current study was to determine the reliability of the Hill-Bone Compliance Scale among elderly hypertensive patients.

Methods

We conducted a cross-sectional survey of community-dwelling patients attending the hypertension section of the Internal Medicine Clinic in a large multispecialty group practice. Participants (n = 239) completed a self-administered questionnaire consisting of demographic questions and the Hill-Bone Compliance to High Blood Pressure Therapy Scale, which includes a nine-item medication compliance subscale.

Results

The mean age of respondents was 69 years; 51% of patients were men, 73% were white, 86% had at least a high school education, and 61% were married. The Cronbach alpha was 0.68 for the medication compliance subscale. All nine items of the medication compliance subscale maintained higher correlations with their own subscale total than with the salt intake and appointment keeping subscale totals. After adjusting for other demographic variables, the odds ratio (95% confidence interval) of perfect medication compliance as reported on the medication compliance subscale was 1.71 (0.95–3.07) for participants 65 years of age and older versus those younger than 65 years of age, 2.53 (1.37–4.66) for whites versus non-whites, 1.27 (0.73–2.20) for males versus females, 1.30 (0.73–2.29) for married versus unmarried participants, and 1.63 (0.74–3.62) for those with at least a high school education versus those with less education.

Conclusion

The medication compliance subscale of the Hill-Bone Compliance Scale appears reliable and may be a useful tool for detecting noncompliant patients in outpatient settings.

Section snippets

Study Design and Study Participants

We conducted a cross-sectional survey of community-dwelling patients attending the hypertension section of the Internal Medicine Clinic in a large multispecialty group practice. Patients checking in for routine appointments with their physician between December 16, 2003 and January 23, 2004 were asked to complete the self-administered questionnaire, which consisted of demographic questions and the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Although trained research personnel

Results

Baseline characteristics of the participants by gender are presented in Table 1. The mean age of the 239 participants who completed the survey was 69 years; 51% of patients were men, 73% were white, 86% had at least a high school education, and 61% were married. The distribution of the responses to each item in the Hill-Bone Compliance to High Blood Pressure Therapy Scales is presented in Table 2. For each item comprising the medication compliance subscale of the scales (items 1, 2, 8–14), more

Discussion

The importance of hypertensive patients’ compliance to prescribed therapy has been previously described.17., 18., 19., 20. Measuring patient compliance with therapies is a first step towards a better understanding of noncompliance and prevention of poor blood pressure control and adverse outcomes. Yet, measurement of medication compliance in outpatient settings is not routinely done. A previous study by Kim and colleagues described the psychometric properties of the Hill-Bone scale in urban,

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    Source of Support: Ochsner Clinic Foundation

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