Brief Adherence Rating Scale (BARS)

The Brief Adherence Rating Scale (BARS) is a simple, 4-item questionnaire used to assess a patient’s adherence to their prescribed medication regimen.
Description: The Brief Adherence Rating Scale (BARS) is a simple, 4-item questionnaire used to assess a patient’s adherence to their prescribed medication regimen.
Disease States: General
Validated Uses: Treatment Monitoring & Evaluation
Administration Method: Clinician-report
Time to administer: Less than 5 minutes
Commonly used in: Clinical Practice
Detailed Description: Medication nonadherence is common in patients with psychiatric conditions and is 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% to 100%).3 The 3 questions probe patients’ knowledge about their medication regimen: number of prescribed doses per day, number of days the patient did not take the prescribed dose, and number of days the patient took less than the prescribed dose.Consistent with previous research, binary 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; Administration Method: Clinician-report3,4; Time to administer: < 5 minutes3; Commonly used in: Clinical Practice3,4
 

This resource is intended for educational purposes only and is intended for US healthcare professionals. Healthcare professionals should use independent medical judgment. All decisions regarding patient care must be handled by a healthcare professional and be made based on the unique needs of each patient.

ABBV-US-00420-MC, Version 2.0
Approved 04/2024 
AbbVie Medical Affairs 

References:

  1. Stirratt MJ, Dunbar-Jacob J, Crane HM, et al. Self-report measures of medication adherence behavior: recommendations on optimal use. Transl Behav Med. 2015;5(4):470-482. doi:10.1007/s13142-015-0315-2 
  2. Nguyen TM, La Caze A, Cottrell N. What are validated self-report adherence scales really measuring?: a systematic review. Br J Clin Pharmacol. 2014;77(3):427-445. doi:10.1111/bcp.12194 
  3. Byerly MJ, Nakonezny PA, Rush AJ. The Brief Adherence Rating Scale (BARS) validated against electronic monitoring in assessing the antipsychotic medication adherence of outpatients with schizophrenia and schizoaffective disorder. Schizophr Res. 2008;100(1-3):60-69. doi:10.1016/j.schres.2007.12.470 
  4. Sajatovic M, Velligan DI, Weiden PJ, Valenstein MA, Ogedegbe G. Measurement of psychiatric treatment adherence. J Psychosom Res. 2010;69(6):591-599. doi:10.1016/j.jpsychores.2009.05.007 
  5. Stroup TS, McEvoy JP, Swartz MS, et al. The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project: schizophrenia trial design and protocol development. Schizophr Bull. 2003;29(1):15-31. doi:10.1093/oxfordjournals.schbul.a006986

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