title: How effectively are your patients taking their medicines? A critical review of the Strathclyde Compliance Risk Assessment Tool in relation to the 'MMAS' and 'MARS'.
abstract: OBJECTIVE
  A useful assessment tool that can support health care professionals in anticipating elderly patients' care needs regarding additional support in managing their own medicines is essential, but currently lacking. Thus, the aim of the study was to assess whether the 13-item Strathclyde Compliance Risk Assessment Tool (SCRAT) is an appropriate instrument for identifying community-dwelling elderly people who may be at risk of medication non-adherence.
  
  
  METHODS
  An 8-week survey was performed from October to November 2009. Patients were ≥65 years old, receiving ≥3 medications and were either using multi-compartment compliance aids or receiving social care support, or both. The data were collected in 45 face-to-face structured interviews using the 13-item SCRAT, 5-item Medication Adherence Rating Scale (MARS) and 8-item Modified Morisky Adherence Scale (MMAS) in sheltered housing complexes in Glasgow, Scotland. Interviews were analysed quantitatively using SPSS version 21 software.
  
  
  RESULTS
  The SCRAT instrument showed substantial inter-rater reliability (Cohen's kappa of 0.730 for the 13-item scale). There was a significant strong negative correlation between the 13-item SCRAT total risk score and 8-item MMAS (r = -0.654; P = 0.0036), and the 13-item SCRAT total risk score and 5-item MARS (r = -0.481; P = 0.0084). The SCRAT instrument showed satisfactory internal consistency (Cronbach's alpha of 0.853 for the 13-item scale). The area under the receiver operator characteristic curve (AUC ± standard error; 95% confidence interval) showed that the SCRAT had good discriminatory capacity and was able to distinguish between adherent and non-adherent participants on the MARS (0.729 ± 0.17; 0.39, 1.00). The best cut-off (sensitivity, specificity) was <3 (75%, 45%). In the sub-analyses, there was a significant difference in total risk score (3 vs. 2, P = 0.011) between users and non-users of multi-compartment compliance aids.
  
  
  CONCLUSIONS
  The study shows that the 13-item SCRAT has the potential to be used in identifying elderly participants who may have problems managing their own medicines and it may help to determine the level and type of assistance that patients require to manage their medicines.
authors.affiliation: Department of Clinical and Pharmacy Practice, College of Clinical Pharmacy, University of Dammam, Dammam, Saudi Arabia.
authors.forename: Faten
authors.initials: F
authors.lastname: Alhomoud
authors.affiliation: Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Mecca, Saudi Arabia.
authors.forename: Farah
authors.initials: F
authors.lastname: Alhomoud
authors.affiliation: Institute of Pharmacy and Biomedical Sciences, Department of Pharmaceutical Care, University of Strathclyde, Glasgow, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Millar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D055118:Medication Adherence; D018802:Patient-Centered Care; D018570:Risk Assessment; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: evaluation; patient-centred care; person-centred medicine