Consistent with previous studies of the MPR in patients with osteoporosis [10, 15, 34], we considered patients with an MPR above 0.80 to be adherent. In addition, a cut-off of 0.68 was also considered, since this
threshold has been demonstrated to be the most sensitive for predicting elevated fracture risk in poorly compliant patients [35]. The MMAS [21] is a self-administered rating scale Sirolimus in vivo that contains four items relating to medication use behaviour. Each item can be scored ‘yes’ or ‘no’, negative replies being attributed a value of 1 and affirmative replies a value of 0. A high score is associated with good adherence and a score of less than 4 is considered to indicate inadequate adherence. This scale was initially developed with eight items for evaluating adherence to antihypertensive medication, but the four-item short form used in our study is now a generic scale that has been applied to many types of medication. In addition, we also collected information on the physician’s Belnacasan nmr appreciation of their patient’s adherence. They were asked whether they thought that their patient was adherent all of the time, most of the time, from time to time, rarely or
never, or whether they had no idea. The purpose of this question was to investigate how well the physician could judge their patient’s adherence without the use of a specific tool. Finalisation of the ADEOS questionnaire and definition of an adherence index For this purpose, the ADEOS study population was divided randomly into two independent data sets. The first set (modelling set) was used to generate the structure of the ADEOS score distribution and the second (validation set) to valid this structure independently. The
first 200 randomly selected patients were assigned to the modelling set and the remaining 148 to the validation set. In a first step, the modelling set was used to select those items whose scores were most closely correlated with an independent measure of adherence, the MMAS score. All items associated with the MMAS score were retained in the final questionnaire. From the items retained, an adherence index was derived by adding the scores of the individual items, having standardised the direction of the response modality so that the highest PDK4 individual item score always corresponded to the greatest adherence. The score was then tested in the validation set by describing its ability to discriminate between adherent and non-adherent patients assigned by the MMAS score (MMAS score = 4 and MMAS score <4, respectively). Finally, relationships were evaluated between the score and the MPR and between the score and the physician’s judgement of patient adherence in the total ADEOS study population. Prediction of treatment discontinuation Patient persistence was assessed 9 months after ADEOS completion using prescriptions made to the patients.