International Journal of Clinical Pharmacy

, Volume 38, Issue 6, pp 1362–1366 | Cite as

Comparing medication adherence tools scores and number of controlled diseases among low literacy patients discharged from a Brazilian cardiology ward

  • Patrícia Carvalho Baruel OkumuraEmail author
  • Lucas Miyake Okumura
  • Wálleri Christini Torelli Reis
  • Rangel Ray Godoy
  • Bianca de Oliveira Cata-Preta
  • Thais Teles de Souza
  • Maria Luiza Drechsel Fávero
  • Cassyano Januário Correr
Short Research Report


Background Adherence to prescribed drug therapy is associated with lower rates of cardiovascular causes of death. In view of the relevance for public health, it is important to understand the relation between medication adherence tools’ scores, especially in low literacy patients discharged from a cardiology ward. Objectives We aimed to assess: (a) the association between number of controlled clinical conditions and adherence tools scores, and (b) the correlation between the scores of three instruments to assess adherence. Methods We conducted a prospective study and included patients discharged from a specialized cardiovascular ward in Brazil. The results of the Beliefs about Medicines questionnaire (BMQ), the Adherence to Refills and Medication Scale (ARMS) and the MedTake test were compared. Results Of 53 included patients, most of them were elderly, and did not complete primary school. On average, there were six health conditions per patient, where two of them were not controlled. ARMS was the only tool that was associated with number of controlled health conditions (r = −0.312, p < 0.05). Moreover, ARMS (average score 15.6 ± 3.4) had significant correlation with MEDTAKE (r = 0.535, p < 0.01) and BMQ (r = 0.38, p < 0.01). BMQ and MEDTAKE were also positively correlated (r = 0.311, p < 0.05). Conclusions Clinically, higher ARMS scores (>12) suggest assumed non-adherence. It is also negatively correlated with the number of controlled clinical conditions in low literacy elderlies with cardiovascular diseases.


Brazil Medication adherence Patient compliance Pharmaceutical care Polypharmacy 



This study had the indispensable work of residents from Hospital de Clínicas/UFPR. Professors, MSc and Ph.D. candidates from the Pharmaceutical Sciences Post Graduate Program were also responsible for the success of the current outpatient services. By the time the study was conducted, PCBO, LMO and BOCP received monthly scholarships from the Brazilian Ministry of Education as resident pharmacists from Hospital de Clínicas/UFPR (Programa de Residência Integrada Multiprofissional em Atenção Hospitalar).


PBCO, LMO, WCTR, RRG and TST are financially supported by the Brazilian Ministry of Education.

Conflicts of interest

The authors have no conflicts of interest.

Supplementary material

11096_2016_390_MOESM1_ESM.docx (45 kb)
Supplementary material 1 (DOCX 45 kb)


  1. 1.
    Koehler BE, Richter KM, Youngblood L, Cohen BA, Prengler ID, Cheng D, et al. Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. J Hosp Med. 2009;4:211–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Stewart S, Pearson S, Luke CG, Horowitz JD. Effects of homebased intervention on unplanned readmissions and out-of-hospital deaths. J Am Geriatr Soc. 1998;46:174–80.CrossRefPubMedGoogle Scholar
  3. 3.
    Lowry KP, Dudley TK, Oddone EZ, Bosworth HB. Intentional and unintentional nonadherence to antihypertensive medication. Ann Pharmacother. 2005;39:1198–203.CrossRefPubMedGoogle Scholar
  4. 4.
    Mendes EV. Health care networks. Cien Saude Colet. 2010;15:2297–305.CrossRefPubMedGoogle Scholar
  5. 5.
    Raehl CL, Bond CA, Woods T, Patry RA, Sleeper RB. Individualized drug use assessment in the elderly. Pharmacotherapy. 2002;22:1239–48.CrossRefPubMedGoogle Scholar
  6. 6.
    Gellad WF, Grenard JL, Marcum ZA. A systematic review of barriers to medication adherence in the elderly:looking beyond cost and regimen complexity. Am J Geriatr Pharmacother. 2011;9:11–23.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Horne R, Chapman SC, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PLoS One. 2013;8:e80633.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kripalani S, Risser J, Gatti ME, Jacobson TA. Development and evaluation of the Adherence to Refills and Medications Scale (ARMS) among low-literacy patients with chronic disease. Value Health. 2009;12:118–23.CrossRefPubMedGoogle Scholar
  9. 9.
    Salgado T, Marques A, Geraldes L, Benrimoj S, Horne R, Fernandez-Llimos F. Cross-cultural adaptation of the Beliefs about medicines Questionnaire into Portuguese. Sao Paulo Med J. 2013;131:88–94.PubMedGoogle Scholar
  10. 10.
    Bastos-Barbosa RG, Ferriolli E, Moriguti JC, Nogueira CB, Nobre F, UetaI J, et al. Treatment adherence and blood pressure control in older individuals with hypertension. Arq Bras Cardiol. 2012;9:636–41.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  • Patrícia Carvalho Baruel Okumura
    • 1
    Email author
  • Lucas Miyake Okumura
    • 1
  • Wálleri Christini Torelli Reis
    • 2
  • Rangel Ray Godoy
    • 2
  • Bianca de Oliveira Cata-Preta
    • 3
  • Thais Teles de Souza
    • 2
  • Maria Luiza Drechsel Fávero
    • 2
  • Cassyano Januário Correr
    • 2
  1. 1.Clinical Pharmacy DivisionHospital de Clínicas de Porto AlegrePorto AlegreBrazil
  2. 2.Pharmaceutical Sciences Post-graduation ProgramUniversidade Federal do ParanáCuritibaBrazil
  3. 3.Hospital de Clínicas da Universidade Federal do ParanáCuritibaBrazil

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