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Nonadherence is a major public health concern but reliable assessment methods are limited. The Medical Adherence Measure (MAM) was designed as a semi-structured clinical interview to elicit comprehensive and accurate responses from patients regarding adherence during the course of standard clinical care. The measure was developed in three phases and administered to 219 pediatric patients (ages 1.3-23) and/or their parents to assess the content, clinical utility, and ease of use. The MAM has three general regimen domains (medication, diet, clinic attendance) and several treatment specific modules. Items assess knowledge of the prescribed regimen, self-reported adherence, organizational system used to manage the regimen, and perceived barriers to optimal management. The MAM is a screening tool that assists providers in identifying patients at risk for adherence problems, assessing the extent of nonadherence, and targeting specific barriers to care in interventions. The interview emphasizes a supportive patient-provider relationship with the goal of improving patient care.
Nonadherence to medical regimens is a major public health issue that cuts across illnesses, patient populations, and medical recommendations (World Health Organization [WHO], 2003), but adherence tends to decline, particularly during adolescence (Nevins, 2002; Zindani, Streetman, Streetman, & Nasr 2006). Inconsistent, inaccurate, or altogether absent adherence to prescribed medical regimens has been associated with poor clinical outcomes, including increased infections, organ rejection, disease comorbidity, and in some cases even mortality (Rapoff, 1999; Sudan, Shaw, & Langnas, 1998; Vermeire, Hearnshaw, Van Royen, & Denekens, 2001). Additionally, nonadherence can result in higher health care utilization, such as more frequent visits to the emergency department, prolonged hospital admissions, and additional diagnostic procedures, and thus, higher health care costs (Brickman & Yount, 1996; Rapoff, 1999). Despite the obvious benefits of the prescribed regimens and the serious implications of erratic adherence to medical recommendations, nonadherence remains an enormous problem that is difficult to measure, understand, and resolve.
Estimates of adherence rates among pediatric patients vary widely (30%-70%) across studies because different indices are used to measure adherence (Rapoff, 1999). The primary source of the difficulties in capturing and assessing adherence accurately is that valid and reliable adherence measures are lacking. There is no "gold standard" against which to measure adherence behaviors, i.e., no perfect means for obtaining accurate and reliable information regarding patient behavior. In the absence...