Medication adherence: factors and improvement strategies MCQs With Answer

Introduction

This quiz set on Medication adherence: factors and improvement strategies is tailored for M.Pharm students preparing for Hospital & Community Pharmacy (MPP 103T). It covers determinants of adherence, measurement tools, common patterns of nonadherence (intentional vs unintentional, primary nonadherence, persistence), and evidence-based pharmacist-led interventions. Questions emphasize practical aspects such as counseling techniques, technological aids (electronic monitors, mobile reminders), regimen simplification, adherence scales (e.g., MMAS-8), and system-level strategies like refill synchronization and multidisciplinary care. Use these MCQs to deepen understanding of how clinical, social, and logistical factors interact and how pharmacists can design targeted strategies to improve patient outcomes.

Q1. Which of the following best defines “primary nonadherence”?

• Patient starts therapy but stops within the first month
• Patient fills initial prescription but does not take medication as prescribed
• Patient never fills or picks up the first prescribed medication
• Patient takes medication irregularly due to side effects

Correct Answer: Patient never fills or picks up the first prescribed medication

Q2. Which tool is specifically a self-reported questionnaire commonly used to screen medication adherence in outpatient settings?

• Medication Event Monitoring System (MEMS)
• Morisky Medication Adherence Scale (MMAS-8)
• Urine drug assay
• Pharmacy refill adjudication

Correct Answer: Morisky Medication Adherence Scale (MMAS-8)

Q3. Which factor is most characteristic of intentional nonadherence?

• Forgetting doses due to busy schedule
• Complex dosing schedule with multiple daily doses
• Deliberate discontinuation because of perceived side effects
• Physical inability to open medication packaging

Correct Answer: Deliberate discontinuation because of perceived side effects

Q4. Which intervention primarily addresses unintentional nonadherence?

• Motivational interviewing to change beliefs
• Providing pill organizers and reminders
• Switching from brand to generic medication
• Changing medication due to adverse reaction

Correct Answer: Providing pill organizers and reminders

Q5. Which statement best describes “persistence” in medication-taking behavior?

• Taking medication exactly at the prescribed times every day
• Filling the initial prescription promptly
• Duration from initiation to discontinuation of therapy
• Complete adherence during the first week of therapy

Correct Answer: Duration from initiation to discontinuation of therapy

Q6. The Medication Event Monitoring System (MEMS) provides adherence data by:

• Counting pills remaining in the blister pack
• Recording each opening of a specially capped medication bottle
• Measuring drug concentration in plasma
• Logging patient self-reports via telephone

Correct Answer: Recording each opening of a specially capped medication bottle

Q7. Which socioeconomic barrier most commonly contributes to medication nonadherence?

• Lack of understanding of dosing instructions
• High out-of-pocket medication costs
• Inconvenient pharmacy hours
• Language discordance with provider

Correct Answer: High out-of-pocket medication costs

Q8. Which pharmacy-led strategy is most effective for improving adherence for patients on multiple chronic medicines?

• Switching all medicines to over-the-counter status
• Refill synchronization and packaging into weekly blister packs
• Instituting generic substitution without counseling
• Sending monthly generic drug promotional materials

Correct Answer: Refill synchronization and packaging into weekly blister packs

Q9. Which measure is an objective indirect measure of adherence at the population level?

• Morisky self-report score
• Electronic bottle opening records
• Pharmacy refill rate (e.g., medication possession ratio)
• Patient diary of missed doses

Correct Answer: Pharmacy refill rate (e.g., medication possession ratio)

Q10. Which clinical scenario suggests poor adherence rather than drug resistance?

• Complete loss of response despite therapeutic drug levels
• Subtherapeutic drug concentration and unpredictable dosing history
• Adverse event documented after dose escalation
• Laboratory-confirmed drug-drug interaction reducing efficacy

Correct Answer: Subtherapeutic drug concentration and unpredictable dosing history

Q11. A pharmacist uses motivational interviewing to address adherence. Which technique is central to this approach?

• Providing didactic lectures about disease pathophysiology
• Confronting the patient about noncompliance
• Exploring ambivalence and eliciting patient’s own motivations
• Prescribing an adherence contract with penalties

Correct Answer: Exploring ambivalence and eliciting patient’s own motivations

Q12. Which medication characteristic is most strongly associated with lower adherence rates?

• Once-daily dosing
• Oral route with minimal side effects
• Multiple daily dosing and complex titration
• Long half-life allowing flexible dosing

Correct Answer: Multiple daily dosing and complex titration

Q13. Which laboratory method can objectively confirm recent intake of a medication when adherence is in question?

• Pharmacy refill records
• Therapeutic drug monitoring (plasma level measurement)
• Patient-completed adherence questionnaire
• Pill count conducted at home

Correct Answer: Therapeutic drug monitoring (plasma level measurement)

Q14. For long-term chronic therapy, which system-level intervention improves adherence across patient populations?

• Limiting prescriptions to 7-day supplies only
• Implementing medication therapy management and follow-up calls
• Discouraging use of generics to maintain brand loyalty
• Eliminating pharmacist counseling to reduce appointment time

Correct Answer: Implementing medication therapy management and follow-up calls

Q15. What is the major limitation of self-reported adherence measures?

• High cost of implementation
• Objective biochemical verification is required
• Recall and social desirability bias leading to overestimation
• They provide continuous real-time electronic data

Correct Answer: Recall and social desirability bias leading to overestimation

Q16. Which mobile-health intervention has shown benefit in improving adherence in randomized trials?

• Once-only educational video without follow-up
• Automated SMS reminders combined with feedback
• Mass email newsletters on healthy living
• Random push notifications unrelated to medication timing

Correct Answer: Automated SMS reminders combined with feedback

Q17. In designing adherence interventions, which patient factor should be assessed first?

• Patient’s genetic polymorphisms affecting metabolism
• Patient’s specific barriers and reasons for nonadherence
• Cost of alternative medications only
• Provider’s convenience in prescribing one formulation

Correct Answer: Patient’s specific barriers and reasons for nonadherence

Q18. Which statement correctly distinguishes adherence from compliance in modern clinical practice?

• Compliance implies shared decision-making, adherence implies passive following
• Adherence emphasizes patient involvement and agreement with the regimen
• They are interchangeable with no difference in nuance
• Compliance is measured, adherence cannot be quantified

Correct Answer: Adherence emphasizes patient involvement and agreement with the regimen

Q19. Which pharmacy packaging intervention can reduce dosing errors and improve adherence in elderly patients with polypharmacy?

• Dispensing all medicines in original manufacturer bottles without labels
• Unit-of-use blister packs with clear daily dosing windows
• Dispensing medications loose in a single multi-compartment bag
• Providing all medications in identical pill form to simplify appearance

Correct Answer: Unit-of-use blister packs with clear daily dosing windows

Q20. Which outcome is the most direct clinical benefit expected from improved medication adherence in chronic diseases?

• Immediate elimination of all side effects
• Reduced morbidity and better disease control over time
• Increase in pharmacy dispensing revenue only
• Guaranteed reduction in medication costs for patients

Correct Answer: Reduced morbidity and better disease control over time

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