title: Utility of the Morisky Medication Adherence Scale in gout: a prospective study.
abstract: BACKGROUND
  The outcomes of any chronic illness often depend on patients' adherence with their treatment. A tool is lacking to assess adherence in gout that is standardized, allows real-time feedback, and is easy to understand.
  
  
  OBJECTIVE
  We set out to evaluate the utility of the 8-item Morisky Medication Adherence Scale (MMAS-8) in monitoring medication adherence in a multiethnic Asian gout cohort on urate-lowering therapy (ULT).
  
  
  METHODS
  This cohort study recruited patients with gout where baseline and 6-monthly clinical data, self-report of adherence, and health status by Gout Impact Scale (GIS) and EuroQoL-5 dimension 3 levels were collected. Those who received at least 9 months of ULT were analyzed. Convergent and construct validities of MMAS-8 were evaluated against medication possession ratio (MPR) and known groups, clinical outcomes, and patient-reported outcomes. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively.
  
  
  RESULTS
  Of 91 patients, 92.3% were male, 72.5% Chinese with mean age 53.5 years. MMAS-8 (mean 6.17) and MPR (mean 96.3%) were poorly correlated (r=0.069,P=0.521). MMAS-8 did not differ between those who did or did not achieve target serum urate (SU) <360 µmol/L (P=0.852); or among those whose SU improved, stagnated, or worsened during follow-up (P=0.777). Adherence was associated with age (β=0.256,P=0.015) and education level (P=0.011) but not comorbidities, polypharmacy, or flare frequency. Concerns for medication side effects and anxiety or depression were associated with lower MMAS-8 (P<0.005). Internal consistency was acceptable (α=0.725) and test-retest reliability was satisfactory (ICC =0.70, 95% confidence interval [CI] 0.36-0.88).
  
  
  CONCLUSIONS
  MMAS-8 had limited construct validity in assessing medication adherence to ULT in our gout patients. Nevertheless, it identified patients bothered or worried about ULT side effects, and those with underlying anxiety or depression, for whom targeted education and coping support may be useful.
authors.affiliation: University Medicine Cluster, Division of Rheumatology, National University Health System.
authors.forename: Csl
authors.initials: C
authors.lastname: Tan
authors.affiliation: University Medicine Cluster, Division of Rheumatology, National University Health System; Department of Medicine, Yong Loo Lin School of Medicine.
authors.forename: G G
authors.initials: GG
authors.lastname: Teng
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine.
authors.forename: K J
authors.initials: KJ
authors.lastname: Chong
authors.affiliation: University Medicine Cluster, Division of Rheumatology, National University Health System; Department of Medicine, Yong Loo Lin School of Medicine.
authors.forename: P P
authors.initials: PP
authors.lastname: Cheung
authors.affiliation: University Medicine Cluster, Division of Rheumatology, National University Health System; Department of Medicine, Yong Loo Lin School of Medicine.
authors.forename: Ayn
authors.initials: A
authors.lastname: Lim
authors.affiliation: Department of Pharmacy, Faculty of Science; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: H L
authors.initials: HL
authors.lastname: Wee
authors.affiliation: University Medicine Cluster, Division of Rheumatology, National University Health System; Department of Medicine, Yong Loo Lin School of Medicine.
authors.forename: A
authors.initials: A
authors.lastname: Santosa
keywords: 8-item Morisky Medication Adherence Scale; MMAS-8; Singapore; gout; serum urate; urate-lowering therapy