Medication adherence measurement methods MCQs With Answer

Introduction: Medication adherence measurement methods MCQs With Answer is a concise question bank designed for M.Pharm students studying Pharmacoepidemiology & Pharmacoeconomics. This set focuses on the theoretical foundations, practical applications, strengths and limitations of direct and indirect adherence measurement methods—including self-report scales, pill counts, pharmacy refill metrics (MPR and PDC), electronic monitoring (MEMS), biochemical assays, and administrative claims data. The questions emphasize calculation, interpretation, common biases, and contexts where each method performs best. These MCQs aim to deepen conceptual understanding, prepare students for exams, and foster critical thinking for designing adherence studies and choosing appropriate metrics in clinical and real-world settings.

Q1.
Which of the following best describes the Medication Possession Ratio (MPR)?

• Total days’ supply dispensed over a period divided by number of days in that period
• Proportion of days covered by medication over a specified interval
• Number of doses taken divided by number of doses prescribed
• Time from therapy start to discontinuation

Correct Answer: Total days’ supply dispensed over a period divided by number of days in that period

Q2.
Which measure is considered more appropriate than MPR when patients have overlapping refills and when a ceiling of 100% adherence is required?

• Medication Possession Ratio (MPR)
• Proportion of Days Covered (PDC)
• Directly Observed Therapy (DOT)
• Self-reported Visual Analogue Scale

Correct Answer: Proportion of Days Covered (PDC)

Q3.
Which of the following is a direct method of measuring adherence?

• Electronic medication event monitoring system (MEMS)
• Drug concentration measurement in blood
• Pharmacy refill records
• Self-report questionnaire such as MMAS

Correct Answer: Drug concentration measurement in blood

Q4.
What is a major limitation of using self-report adherence questionnaires (e.g., Morisky Scale)?

• They are expensive and require laboratory analysis
• They are subject to recall and social desirability bias
• They provide exact timestamps for each pill ingestion
• They overestimate adherence only for short-term medications

Correct Answer: They are subject to recall and social desirability bias

Q5.
Which electronic measure provides detailed timing of container openings and is often used as a reference for adherence behavior in research?

• Pharmacy refill records
• Electronic Medication Event Monitoring System (MEMS)
• Directly observed therapy
• Medication diary

Correct Answer: Electronic Medication Event Monitoring System (MEMS)

Q6.
In claims-based studies, which phenomenon can lead to overestimation of adherence because possession does not ensure ingestion?

• Primary nonadherence
• White-coat adherence
• Stockpiling or hoarding of medication
• Therapeutic drug monitoring

Correct Answer: Stockpiling or hoarding of medication

Q7.
How is Proportion of Days Covered (PDC) commonly calculated over a fixed observation period?

• Sum of days supplied divided by observation period, capped at 100% for overlapping supplies
• Number of refills divided by days in period
• Number of pills reported taken divided by number prescribed
• Days from first fill to last fill

Correct Answer: Sum of days supplied divided by observation period, capped at 100% for overlapping supplies

Q8.
Which adherence metric is most sensitive to measurement interval selection and can vary substantially when the observation window changes?

• Therapeutic drug monitoring
• Proportion of Days Covered (PDC)
• Medication Possession Ratio (MPR)
• Directly Observed Therapy (DOT)

Correct Answer: Medication Possession Ratio (MPR)

Q9.
Primary nonadherence refers to which scenario?

• Patient never fills the initial prescription
• Patient reduces dose without consulting clinician
• Patient discontinues medication after several refills
• Patient misses occasional doses but continues therapy

Correct Answer: Patient never fills the initial prescription

Q10.
Which of the following is a key advantage of directly measuring drug/metabolite levels over electronic monitoring?

• Provides objective evidence of systemic exposure and ingestion
• Is inexpensive and easy to implement at population level
• Records exact timing of each dose taken at home
• Unaffected by pharmacokinetic variability between patients

Correct Answer: Provides objective evidence of systemic exposure and ingestion

Q11.
Which bias occurs when patients temporarily improve adherence around clinic visits?

• Selection bias
• White-coat adherence
• Recall bias
• Observer-expectancy effect

Correct Answer: White-coat adherence

Q12.
When validating a new self-report adherence instrument, which psychometric property assesses whether the tool produces consistent results over repeated administrations?

• Construct validity
• Test–retest reliability
• Content validity
• Responsiveness

Correct Answer: Test–retest reliability

Q13.
Which approach is recommended to improve accuracy by combining strengths of different adherence measures?

• Using only pharmacy refill data because it is objective
• Triangulation or multimethod assessment
• Relying exclusively on patient self-report for feasibility
• Measuring adherence once at baseline

Correct Answer: Triangulation or multimethod assessment

Q14.
For chronic medications, an adherence threshold of 80% is commonly used. What is a limitation of applying a fixed threshold across all drug classes?

• It underestimates adherence for all chronic conditions
• Different medications have different exposure–response relationships, so the clinical relevance of 80% varies
• Thresholds are only relevant for short-term antibiotics
• It is universally accepted and has no limitation

Correct Answer: Different medications have different exposure–response relationships, so the clinical relevance of 80% varies

Q15.
Which of the following best explains why electronic pillbox openings may not equal ingestion?

• MEMS devices are inaccurate and do not record timestamps
• Patients can open the container without taking a dose or remove multiple doses at once
• Electronic devices always confirm ingestion through saliva sensors
• Pillbox openings are only used in inpatient settings

Correct Answer: Patients can open the container without taking a dose or remove multiple doses at once

Q16.
Which measure specifically quantifies persistence rather than adherence?

• Proportion of Days Covered (PDC)
• Medication Possession Ratio (MPR)
• Time to discontinuation (duration of therapy)
• Self-reported missed doses per week

Correct Answer: Time to discontinuation (duration of therapy)

Q17.
In administrative claims data, which indicator is commonly used as a proxy for adherence to long-term medications in observational pharmacoepidemiology?

• Number of clinician visits
• Refill adherence measures such as PDC or MPR
• Self-reported questionnaires recorded in claims
• Laboratory drug concentration values

Correct Answer: Refill adherence measures such as PDC or MPR

Q18.
Which concept describes the extent to which a patient continues treatment for the prescribed duration?

• Adherence
• Persistence
• Concordance
• Compliance bias

Correct Answer: Persistence

Q19.
When calculating PDC for multiple medications within the same therapeutic class, which practice is recommended?

• Calculate PDC for each medication and report the maximum value only
• Define PDC based on coverage by any drug within the class to reflect therapeutic coverage
• Exclude refill overlaps and treat each refill independently without capping at 100%
• Use pill counts instead because PDC is invalid for classes

Correct Answer: Define PDC based on coverage by any drug within the class to reflect therapeutic coverage

Q20.
Which of the following is a pragmatic limitation when using therapeutic drug monitoring (TDM) as an adherence measure in large-scale studies?

• TDM provides no objective evidence of ingestion
• TDM is costly, invasive, and affected by pharmacokinetic variability
• TDM cannot distinguish between long-term and short-term adherence patterns
• TDM always overestimates adherence due to laboratory errors

Correct Answer: TDM is costly, invasive, and affected by pharmacokinetic variability

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