Proposal for a Global Adherence Scale for Acute Conditions (GASAC): A prospective cohort study in two emergency departments

Autoři: Mélanie Sustersic aff001;  Aurélie Gauchet aff003;  Amélie Duvert aff004;  Laure Gonnet aff004;  Alison Foote aff004;  Céline Vermorel aff002;  Benoit Allenet aff002;  Jean-Luc Bosson aff002
Působiště autorů: Emergency Department, Grenoble Mutualist Hospital Group (Groupe Hospitalier Mutualiste de Grenoble), Grenoble, France aff001;  TIMC-IMAG, CNRS-UMR 5525, Univ. Grenoble Alpes, Grenoble, France aff002;  Inter-University Psychology Laboratory, EA 4145, Univ. Grenoble Alpes, Grenoble, France aff003;  Research Division, Grenoble Alpes University Hospital, Grenoble, France aff004
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article



Adherence in the context of patients with acute conditions is a major public health issue. It is neglected by the research community and no clinically validated generic scale exists to measure it.


To construct and validate a Global Adherence Scale usable in the context of Acute Conditions (GASAC) that takes into account adherence both to advice and to all types of prescriptions that the doctor may give. To measure adherence and to study its determinants.

Materials and method

We based the construction of the GASAC questionnaire on a theoretical model and a literature search. Then, between 2013 and 2014, we validated it in a prospective observational study in two hospital emergency departments. Patients were contacted by phone about one week after their consultation to answer several questionnaires, including GASAC and the Girerd self-administered questionnaire about medication adherence as a control.


GASAC consists of four adherence subscales: drug prescriptions; blood tests/ radiography prescriptions; lifestyle advice and follow-up instructions. An analysis of the 154 sets of answers from patients showed that the GASAC drug subscale had satisfactory internal coherence (Cronbach’s alpha = 0.78) and was correlated with the Girerd score, as was GASAC as a whole (p<0.01). The median score was 0.93 IQR [0.78–1] for a maximum value of 1 (n = 154). In multivariaable analysis, infection was more conducive of good adherence (cut off at ≥ 0.8; n = 115/154; 74.7% [67.0–81.3]) than trauma (OR 3.69; CI [1.60–8.52]). The Doctor-Patient Communication score (OR 1.06 by score point, CI [1.02–1.10]) also influenced adherence.


GASAC is a generic score to measure all dimensions of patient adherence following emergency departments visits, for use in clinical research and the evaluation of clinical practice. The level of adherence was high for acute conditions and Doctor-Patient Communication was a major determinant of adherence.

Klíčová slova:

Ankles – Critical care and emergency medicine – Database searching – Diet – Drug adherence – Medical doctors – Patients – Questionnaires


1. Allenet B, Baudrant M, Lehmann A, Gauchet A, Roustit M, Bedouch P, et al. [How can we evaluate medication adherence? What are the methods?]. Ann Pharm Fr 2013;71:135–41. doi: 10.1016/j.pharma.2012.10.001 23537415

2. Sabate E. Adherence to long-term therapies. Evidence for action. Geneva: World Health Organization 2003; Available from:

3. Ito H. What Should We Do to Improve Patients’Adherence? J Exp Clin Med 2013; 5:127–30.

4. Haynes RB, Mc Donald HP, Garg AX. Helping patients follow prescribed treatment: clinical applications. J Am Med Assoc 2002;288:2880–3.

5. Gauchet A, Tarquinio C, Fischer G. Psychosocial predictors of medication adherence among persons living with HIV. Int J Behav Med 2007;14:141–50. doi: 10.1007/bf03000185 18062057

6. Sileo KM, Kizito W, Wanyenze RK, Chemusto H, Reed E, Stockman JK, et al. Substance use and its effect on antiretroviral treatment adherence among male fisherfolk living with HIV/AIDS in Uganda. PLoS One. 2019 Jun;14(6).

7. Virjens B, De Geest S, Hughes DA, Przemyslaw K, Demonceau J, Ruppar T, et al. A new taxonomy for describing and defining adherence to medications: new taxonomy for adherence to medications. Br J Clin Pharmacol 2012; 3: 691–705.

8. McDonald HP, Garg AX, Haynes RB. Interventions to Enhance Patient Adherence to Medication Prescriptions: Scientific Review. J Am Med Assoc 2002; 288: 2868–2879.

9. Raynor DK, Blenkinsopp A, Knapp P, Grime J, Nicolson DJ, Pollock K, et al. A systematic review of quantitative and qualitative research on the role and effectiveness of written information available to patients about individual medicines. Health Technol Assess Winch Engl 2007;11: 1–160.

10. Girerd X, Hanon O, Anagnostopoulos K, Ciupek C. Assessment of antihypertensive compliance using a self-administered questionnaire: development and use in a hypertension clinic. Presse Med. 2001 Jun 16–23;30(21):1044–8. 11471275

11. Girerd X, Radauceanu A, Achard JM. Evaluation of patient compliance among hypertensive patients treated by specialists. Arch Mal Cœur Vaiss.2001 Aug;94(8):839–42. 11575214

12. Ridgeway K, Dulli LS, Murray KR, Silverstein H, Dal Santo L, Olsen P, et al. Interventions to improve antiretroviral therapy adherence among adolescents in low- and middle-income countries: A systematic review of the literature. PLoS One. 2018;13(1).

13. Murage MJ, Tongbram V, Feldman SR, Malatestinic WN, Larmore CJ, Muram TM, et al. Medication adherence and persistence in patients with rheumatoid arthritis, psoriasis, and psoriatic arthritis: a systematic literature review. Patient Prefer Adherence. 2018 Aug 21;12:1483–1503. doi: 10.2147/PPA.S167508 30174415

14. Haynes RB, Taylor WD, Sackett DL. Compliance in health care. Baltimore: Johns Hopkins University Press 1979; 1–15.

15. Sustersic M, Gauchet A, Foote A, Bosson JL. How best to use and evaluate Patient Information Leaflets given during a consultation: a systematic review of literature reviews. Health Expect 2016; 1–12.

16. Sustersic M, Tyrant J, Tissot M, Gauchet A, Foote A, Vermorel C, et al. Impact of patient information leaflets on doctor–patient communication in the context of acute conditions: a prospective controlled before–after study in two French emergency departments. BMJ Open 2019;9:e024184. doi: 10.1136/bmjopen-2018-024184 30787085

17. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther 2001;26:331–42. doi: 10.1046/j.1365-2710.2001.00363.x 11679023

18. Lavsa SM, Holzworth A, Ansani NT. Selection of a validated scale for measuring medication adherence. J Am Pharm Assoc 2011; 51:90–4.

19. Lehmann A, Aslani P, Ahmed R, Celio J, Gauchet A, Bedouch P, et al. Assessing medication adherence: options to consider. Int J Clin Pharm 2013; 36: 55–69. doi: 10.1007/s11096-013-9865-x 24166659

20. Garfield S, Clifford S, Eliasson L, Barber N, Willson. Suitability of measures of self- reported medication adherence for routine clinical use: A systematic review. BMC Med Res Methodol 2011;11:149. doi: 10.1186/1471-2288-11-149 22050830

21. Voils CI, Hoyle RH, Thorpe CT. Improving the measurement of self-reported medication nonadherence. J Clin Epidemiol 2011;64:250–4. doi: 10.1016/j.jclinepi.2010.07.014 21194887

22. French society of general practitioners (SFMG).

23. Ackermann S, Bingisser MB, Heierle A. Discharge communication in the emergency department: physicians underestimate the time needed. Swiss Med Wkly 2012;142: 1–6.

24. Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med. 2007;2(5):314–23. Epub 2007/10/16 doi: 10.1002/jhm.228 17935242

25. Makaryus AN, Friedman EA. Patients’understanding of their treatment plans and diagnosis at discharge. Mayo Clin Proc 2005;80:991–4). doi: 10.4065/80.8.991 16092576

26. Laufs U, Rettig-Ewen V, Böhm M. Strategies to improve drug adherence. Eur Heart J 2011; 32:264–8. doi: 10.1093/eurheartj/ehq297 20729544

27. Makinen M, Castren M, Huttunen K,et al. Assessing the discharge instructing in the emergency department: patient perspective. Int Emerg Nurs 2019;43:40–44). doi: 10.1016/j.ienj.2018.07.005 30316733

28. Chung C, Haller DM, Sustersic M, Sommer J. Patient information leaflets—favoring the sustainability of messages provided to patients following an emergency consultation. Rev Med Suisse. 2019 May 8;15(650):965–970. 31066528

29. Dulmen SV, Sluijs E, van Dijk L, de Ridder D, Heerdink R, Bensing J. Patient adherence to medical treatment: a review of reviews. BMC Health Serv Res 2007;7:55. doi: 10.1186/1472-6963-7-55 17439645

30. Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2014: CD000011.

31. DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care 2004;42:200–9. doi: 10.1097/01.mlr.0000114908.90348.f9 15076819

32. Nicolson D, Knapp P, Raynor D, Spoor P, Knapp P. Written information about individual medicines for consumers. Cochrane Database Syst Rev Online 2009;(2):CsD002104.

33. Simmons S, Sharp B, Fowler J, Fowkes H, Paz-Arabo P, Dilt-Skaggs MK, et al. Mind the (knowledge) gap: The effect of a communication instrument on emergency department patients’ comprehension of and satisfaction with care. Patient Educ Couns 2015; 98: 257–262. doi: 10.1016/j.pec.2014.10.020 25468394

34. Bos N, Sizmur S, Graham C, Van Stel HF. The accident and emergency department questionnaire: a measure for patients’ experiences in the accident and emergency department. BMJ Qual Saf 2013;22:139–146. doi: 10.1136/bmjqs-2012-001072 22942399

35. Tarquinio C, Fischer G, Grégoire A. Compliance in HIV-positive patients: validation of a French scale and measurement of psychosocial variables. Rev Int Psychol Soc 2000;13(2):61–91.

36. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens. 2008 May;10(5):348–54.

37. Ruiz MA, Pardo A, Rejas J, Soto J, Villasante F, Aranguren JL. Development and validation of the “Treatment Satisfaction With Medicines Questionnaire” (SATMED-Q). Value Health. Oct 2008; 11(5): 913–926. doi: 10.1111/j.1524-4733.2008.00323.x 18494753

38. AHRQ. Care Coordination Measures Atlas [Internet]. Agency for Healthcare Research and Quality; 2010. Available from:

39. Richard C, Lussier MT. [Professional communication in Health]. 2nd edition.Saint-Laurent, Quebec, Canada: Editions du Renouveau pedagogique; 2016.

40. Garratt AM, Bjærtnes A, Krogstad U, Gulbrandsen P. The OutPatient Experiences Questionnaire (OPEQ): data quality, reliability, and validity in patients attending 52 Norwegian hospitals. Qual Saf Health Care 2005;14:433–437. doi: 10.1136/qshc.2005.014423 16326790

41. Bland JM, Altman DG. Statistics notes: Cronbach’s alpha. BMJ 1997; 314:572. doi: 10.1136/bmj.314.7080.572 9055718

42. Baudrant M. [Reflections on the role of the pharmacist in patient therapeutic education]. J Pharm Clin 2008; 27:201–4.

43. Cramer JA, Scheyer RD, Mattson RH. Compliance declines between clinic visits. Arch Intern Med 1990;150:509e10.

44. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005; 353:487–97. doi: 10.1056/NEJMra050100 16079372

45. Fossli Jensen B, Dahl FA, Safran DG, Garratt AM, Krupat E, Finset A et al. The ability of a behaviour-specific patient questionnaire to identify poorly performing doctors. BMJ Qual Saf 2011; 20: 885–893. doi: 10.1136/bmjqs-2011-000021 21849336

46. Hansoti B, Aluisio AR, Barry MA, Davey K, Lentz BA, Modi P, et al. Global Health and Emergency Care: Defining Clinical Research Priorities. Acad Emerg Med 2017; 24(6): 742–753. doi: 10.1111/acem.13158 28103632

Článek vyšel v časopise


2019 Číslo 12
Nejčtenější tento týden