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Brief Adherence Rating Scale (BARS)

The BARS is a simple, 4-item questionnaire used to assess a patient’s adherence with their prescribed medication regimen.
Description: The BARS is a simple, 4-item questionnaire used to assess a patient’s adherence with their prescribed medication regimen.
Disease States: General
Validated Uses: Treatment Monitoring & Evaluation
Populations: Adult
Administration Method: Clinician-report
Time to administer: < 5 minutes
Commonly used in: Clinical Practice
Detailed Description: Medication nonadherence is common in patients with psychiatric conditions and associated with worse clinical outcomes.3,4 Detection of medication nonadherence can also be a challenge for prescribers, with existing methods including electronic monitoring, pill counting, and blood or urine analysis.3 The BARS is an efficient and cost-effective alternative for assessing a patient’s compliance with their prescribed medication regimen.1,3 The tool is administered by a clinician and includes 4 items: 3 questions and an overall visual analog rating scale to estimate the proportion of doses taken by the patient in the past month (0–100%).3 The three questions probe patients’ knowledge about their medication regimen: number of prescribed doses per day, number of days the patient did not take the prescribe dose, and number of days the patient took less than the prescribed dose.Consistent with previous research, biqnary classifications of adherent versus nonadherent typically use a 70% cutoff score.3
Scale Validity: In a validation study comparing the BARS to electronic monitoring in 61 adult patients with schizophrenia, the BARS was found to have a sensitivity of 73% and a specificity of 71%.3
Alternative Versions: The 4-item BARS was derived from a lengthier adherence questionnaire used in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study.3,5
Cited Limitations: While self-report measures of medication adherence are commonly used, they have also been criticized as having limited validity.1,4 Patient self-report may be confounded by factors including social desirability, memory biases, and poor insight.4 These factors may lead to a patient’s adherence behavior being overestimated.1

Footnotes:

†Although the 4-item BARS is described here, we include information about alternative versions for your general awareness and convenience. These alternative versions may be used by different practitioners or in clinical trial or research settings.

Supporting references for the filters are as follows:
Disease States: General1; Validated Uses: Treatment Monitoring & Evaluation1,2; Populations: Adult3; Administration Method: Clinician-report3,4; Time to administer: < 5 minutes3; Commonly used in: Clinical Practice3,4

References:

  1. Stirratt, MJ et al. Transl Behav Med. 2015;5(4):470-482.
  2. Nguyen, TM et al. Br J Clin Pharmacol. 2014;77(3):427-445.
  3. Byerly, MJ et al. Schizophr Res. 2008;100(1-3):60-69.
  4. Sajatovic, M et al. J Psychosom Res. 2010;69(6):591-599.
  5. Stroup, TS et al. Schizophr Bull. 2003;29(1):15-31.

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