Development of a short questionnaire to identify the risk of nonadherence to antibiotic treatment

Abstract

Objective. Nonadherence to the prescribed antibiotic treatment is a widespread problem, affecting not only an individual patient, but also public health. As measures to predict it are still lacking, we aimed to design an instrument to identify nonadherence risk in short-term antibiotic therapies. Methods. Patient adherence was assessed by pill count and extensive set of standardized questions, newly developed according to the 5-dimension adherence model proposed by the World Health Organization. It combined previously validated questionnaires and original questions adapted from our exploratory survey. The extensive set was analyzed prospectively in adult patients treated with antibiotics in outpatient settings. The number of items was reduced stepwise keeping as many of 5 factor subgroups as possible. The items were dichotomized as positive (indicating nonadherence risk) or negative Results. One third (32%) of the respondents (N=122) did not adhere to the prescribed antibiotic regimen. The extensive set of questions was reduced to a short questionnaire. It consisted of 4 items independently associated with nonadherence (P<0.05) and covered 3 of the 5 analyzed factor subgroups: health care-related factor (consultations about medicines), therapy-related factor (complexity of treatment), and patient-related factors (forgetfulness, health behavior). The sum of 0-1 positive answers indicated an adherent patient, while the sum of 2-4, a risky patient. Such a differential approach led to a relatively good sensitivity, specificity, and total predictive value (80%, 82%, and 81%, respectively) in our sample. Conclusion. The short measure representing the multiple factor subgroups was developed to identify nonadherence to antibiotic treatment with the acceptable levels of sensitivity, specificity, and predictive values. It could be valuable for health care professionals, especially in primary health care. [...].