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Coming full circle in the measurement of medication adherence: opportunities and implications for health care

Authors Whalley Buono E, Vrijens B, Bosworth HB, Liu LZ, Zullig LL, Granger BB

Received 9 November 2016

Accepted for publication 3 February 2017

Published 2 June 2017 Volume 2017:11 Pages 1009—1017


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Johnny Chen

Elizabeth Whalley Buono,1 Bernard Vrijens,2 Hayden B Bosworth,3 Larry Z Liu,4 Leah L Zullig,5,6 Bradi B Granger7,8

1VP, Global Quality, External and Regulatory Affairs, MWV Healthcare, Richmond, VA, USA; 2WestRock Healthcare, Visé, Belgium; 3Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, 4Center for Observational and Real World Evidence, Merck, Rahway, NJ and Weill Medical College of Cornell University, New York, NY, 5Division of General Internal Medicine, Duke University School of Medicine, 6Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 7Duke University School of Nursing, 8Heart Center Nursing Research Program, Duke University Health System, Durham, NC, USA

Abstract: There is little debate that medication nonadherence is a major public health issue and that measuring nonadherence is a crucial step toward improving it. Moreover, while measuring adherence is becoming both more feasible and more common in the era of electronic information, the reliability and usefulness of various measurements of adherence have not been well established. This paper outlines the most commonly used measures of adherence and discusses the advantages and disadvantages of each that depend on the purpose for which the measure will be used. International consensus statements on definitions and guidelines for selection and use of medication adherence measures were reviewed. The quality of recommended measures was evaluated in selected publications from 2009 to 2014. The most robust medication adherence measures are often ill suited for large-scale use. Less robust measures were found to be commonly misapplied and subsequently misinterpreted in population-level analyses. Adherence assessment and measurement were rarely integrated into standard patient care practice patterns. Successful scalable and impactful strategies to improve medication adherence will depend on understanding how to efficiently and effectively measure adherence.

Keywords: adherence measures, medication adherence, study design, patient-reported outcomes, research methods

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