Advancing the Science and Practice of Medication Adherence

  • Michael J. Stirratt
  • Jeffrey R. Curtis
  • Maria I. Danila
  • Richard Hansen
  • Michael J. Miller
  • C. Ann Gakumo
Perspective

Abstract

Medication adherence remains a significant unmet challenge for optimizing patient outcomes. Recent advances in the conceptualization, measurement, and support of medication adherence offer fresh opportunities to make a meaningful impact on adherence-related behavior and outcomes. These advances emphasize the multifaceted and dynamic nature of medication adherence, provide novel methods for monitoring medication adherence in clinical care, and articulate a set of multilevel strategies to more effectively improve and sustain medication adherence. Here, we offer recommendations for how clinicians can better engage with, and benefit from, these innovations to improve patient medication adherence and associated treatment outcomes.

KEY WORDS

adherence persistence adherence interventions adherence measures medication adherence 

Notes

Acknowledgements

Dr. Gakumo is supported by the Robert Wood Johnson Foundation Nurse Faculty Scholars Program 72113. Dr. Danila is supported by NIAMS K23 AR062100. The authors would like to thank the UAB “Interdisciplinary Approaches to Understanding and Improving Adherence” conference leaders, and Elizabeth Rahn, PhD, for their review and input in the preparation of this manuscript, and Stacey C. Tobin, PhD, for providing editorial support. Appreciation is also extended to members of the NIH Adherence Network for input on a related UAB conference presentation.

Compliance with Ethical Standards

Conflict of Interest

Drs. Stirratt, Gakumo, Curtis, Danila, and Miller report no conflict of interest. In the past 3 years, Dr. Hansen has provided expert testimony for Boehringer Ingelheim on unrelated matters.

References

  1. 1.
    Briesacher BA, Andrade SE, Fouayzi H, Chan KA. Comparison of drug adherence rates among patients with seven different medical conditions. Pharmacotherapy. 2008;28(4):437-43.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Vink NM, Klungel OH, Stolk RP, Denig P. Comparison of various measures for assessing medication refill adherence using prescription data. Pharmacoepidemiol Drug Saf. 2009;18(2):159-65.CrossRefPubMedGoogle Scholar
  3. 3.
    Yeaw J, Benner JS, Walt JG, Sian S, Smith DB. Comparing adherence and persistence across 6 chronic medication classes. J Manag Care Pharm. 2009;15(9):728-40.PubMedGoogle Scholar
  4. 4.
    Nieuwlaat R, Wilczynski N, Navarro T, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2014(11):CD000011.Google Scholar
  5. 5.
    Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-97.CrossRefPubMedGoogle Scholar
  6. 6.
    Steiner JF. Self-reported adherence measures: what do they assess and how should we use them? Med Care. 2012;50(12):1011-2.CrossRefPubMedGoogle Scholar
  7. 7.
    Voils CI, Hoyle RH, Thorpe CT, Maciejewski ML, Yancy WS, Jr. Improving the measurement of self-reported medication nonadherence. J Clin Epidemiol. 2011;64(3):250-4.CrossRefPubMedGoogle Scholar
  8. 8.
    Vrijens B, De Geest S, Hughes DA, et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012;73(5):691-705.Google Scholar
  9. 9.
    Fischer MA, Stedman MR, Lii J, et al. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010;25(4):284-90.Google Scholar
  10. 10.
    Hutchins DS, Zeber JE, Roberts CS, et al. Initial medication adherence-review and recommendations for good practices in outcomes research: an ISPOR medication adherence and persistence special interest group report. Value Health. 2015;18(5):690-9.Google Scholar
  11. 11.
    DiMatteo MR. Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42(3):200-9.CrossRefPubMedGoogle Scholar
  12. 12.
    Curtis JR, Xi J, Westfall AO, et al. Improving the prediction of medication compliance: the example of bisphosphonates for osteoporosis. Med Care. 2009;47(3):334-41.Google Scholar
  13. 13.
    Hess LM, Raebel MA, Conner DA, Malone DC. Measurement of adherence in pharmacy administrative databases: a proposal for standard definitions and preferred measures. Ann Pharmacother. 2006;40(7–8):1280-88.CrossRefPubMedGoogle Scholar
  14. 14.
    Steiner JF, Prochazka AV. The assessment of refill compliance using pharmacy records: methods, validity, and applications. J Clin Epidemiol. 1997;50(1):105-16.CrossRefPubMedGoogle Scholar
  15. 15.
    Blaschke TF, Osterberg L, Vrijens B, Urquhart J. Adherence to medications: insights arising from studies on the unreliable link between prescribed and actual drug dosing histories. Annu Rev Pharmacol Toxicol. 2012;52:275-301.CrossRefPubMedGoogle Scholar
  16. 16.
    Mathews R, Wang TY, Honeycutt E, et al. Persistence with secondary prevention medications after acute myocardial infarction: Insights from the TRANSLATE-ACS study. Am Heart J. 2015;170(1):62-9.Google Scholar
  17. 17.
    Calip GS, Adimadhyam S, Xing S, Rincon JC, Lee WJ, Anguiano RH. Medication adherence and persistence over time with self-administered TNF-alpha inhibitors among young adult, middle-aged, and older patients with rheumatologic conditions. Semin Arthritis Rheum. 2017. https://doi.org/10.1016/j.semarthrit.2017.03.010
  18. 18.
    Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA. 2002;288(4):455-61.CrossRefPubMedGoogle Scholar
  19. 19.
    Wilson IB, Bangsberg DR, Shen J, et al. Heterogeneity among studies in rates of decline of antiretroviral therapy adherence over time: results from the multisite adherence collaboration on HIV 14 study. J Acquir Immune Defic Syndr. 2013;64(5):448-54.Google Scholar
  20. 20.
    Hommel KA, McGrady ME, Peugh J, et al. Longitudinal patterns of medication nonadherence and associated health care costs. Inflamm Bowel Dis. 2017;23(9):1577-83.Google Scholar
  21. 21.
    Knafl GJ, Bova CA, Fennie KP, O'Malley JP, Dieckhaus KD, Williams AB. An analysis of electronically monitored adherence to antiretroviral medications. AIDS Behav. 2010;14(4):755-68.CrossRefPubMedGoogle Scholar
  22. 22.
    Franklin JM, Shrank WH, Pakes J, et al. Group-based trajectory models: a new approach to classifying and predicting long-term medication adherence. Med Care. 2013;51(9):789-96.Google Scholar
  23. 23.
    Cambiano V, Lampe FC, Rodger AJ, et al. Long-term trends in adherence to antiretroviral therapy from start of HAART. AIDS (London, England). 2010;24(8):1153-62.Google Scholar
  24. 24.
    French T, Tesoriero J, Agins B. Changes in stress, substance use and medication beliefs are associated with changes in adherence to HIV antiretroviral therapy. AIDS Behav. 2011;15(7):1416-28.CrossRefPubMedGoogle Scholar
  25. 25.
    Cadarette SM, Burden AM. Measuring and improving adherence to osteoporosis pharmacotherapy. Curr Opin Rheumatol. 2010;22(4):397-403.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Hansen RA, Dusetzina SB, Dominik RC, Gaynes BN. Prescription refill records as a screening tool to identify antidepressant non-adherence. Pharmacoepidemiol Drug Saf. 2010;19(1):33-7.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Vrijens B, Antoniou S, Burnier M, de la Sierra A, Volpe M. Current situation of medication adherence in hypertension. Front Pharmacol. 2017;8:100.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Berg KM, Arnsten JH. Practical and conceptual challenges in measuring antiretroviral adherence. J Acquir Immune Defic Syndr. 2006;43 Suppl 1:S79-87.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Gonzalez JS, Schneider HE. Methodological issues in the assessment of diabetes treatment adherence. Curr Diab Rep. 2011;11(6):472-9.CrossRefPubMedGoogle Scholar
  30. 30.
    Whalley Buono E, Vrijens B, Bosworth HB, Liu LZ, Zullig LL, Granger BB. Coming full circle in the measurement of medication adherence: opportunities and implications for health care. Patient Prefer Adherence. 2017;11:1009-17.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Chesney MA. The elusive gold standard. Future perspectives for HIV adherence assessment and intervention. J Acquir Immune Defic Syndr. 2006;43 Suppl 1:S149-55.CrossRefPubMedGoogle Scholar
  32. 32.
    Zullig LL, Mendys P, Bosworth HB. Medication adherence: A practical measurement selection guide using case studies. Patient Educ Couns. 2017;100(7):1410-4.CrossRefPubMedGoogle Scholar
  33. 33.
    Campbell JI, Haberer JE. Cell Phone-Based and Adherence Device Technologies for HIV Care and Treatment in Resource-Limited Settings: Recent Advances. Curr HIV/AIDS Rep. 2015;12(4):523-31.CrossRefPubMedGoogle Scholar
  34. 34.
    Hafezi H, Robertson TL, Moon GD, Au-Yeung KY, Zdeblick MJ, Savage GM. An ingestible sensor for measuring medication adherence. IEEE Trans Biomed Eng. 2015;62(1):99-109CrossRefPubMedGoogle Scholar
  35. 35.
    Kane JM, Perlis RH, DiCarlo LA, Au-Yeung K, Duong J, Petrides G. First experience with a wireless system incorporating physiologic assessments and direct confirmation of digital tablet ingestions in ambulatory patients with schizophrenia or bipolar disorder. J Clin Psychiatry. 2013;74(6):e533-40.CrossRefPubMedGoogle Scholar
  36. 36.
    Peters-Strickland T, Pestreich L, Hatch A, et al. Usability of a novel digital medicine system in adults with schizophrenia treated with sensor-embedded tablets of aripiprazole. Neuropsychiatr Dis Treat. 2016;12:2587-94.Google Scholar
  37. 37.
    Thompson D, Mackay T, Matthews M, Edwards J, Peters N, Connolly SB. Direct adherence measurement using an ingestible sensor compared with self-reporting in high-risk cardiovascular disease patients who knew they were being measured: a prospective intervention. JMIR Mhealth Uhealth. 2017;5(6):e76.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Gupta P, Patel P, Strauch B, et al. Risk Factors for Nonadherence to Antihypertensive Treatment. Hypertension. 2017;69(6):1113-20.Google Scholar
  39. 39.
    McNaughton CD, Brown NJ, Rothman RL, et al. Systolic Blood Pressure and Biochemical Assessment of Adherence: A cross-sectional analysis in the emergency department. Hypertension. 2017;70(2):307-14.Google Scholar
  40. 40.
    Zheng JH, Rower C, McAllister K, Castillo-Mancilla J, et al. Application of an intracellular assay for determination of tenofovir-diphosphate and emtricitabine-triphosphate from erythrocytes using dried blood spots. J Pharm Biomed Anal. 2016;122:16-20.Google Scholar
  41. 41.
    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):470-82.Google Scholar
  42. 42.
    Feldman BJ, Fredericksen RJ, Crane PK, et al. Evaluation of the single-item self-rating adherence scale for use in routine clinical care of people living with HIV. AIDS Behav. 2013;17(1):307-18.Google Scholar
  43. 43.
    Crane HM, Crane PK, Tufano JT, et al. HIV provider documentation and actions following patient reports of at-risk behaviors and conditions when identified by a web-based point-of-care assessment. AIDS Behav. 2017. https://doi.org/10.1007/s10461-017-1718-5
  44. 44.
    Callon W, Saha S, Korthuis PT, et al. Which clinician questions elicit accurate disclosure of antiretroviral non-adherence when talking to patients? AIDS Behav. 2016;20(5):1108-15.Google Scholar
  45. 45.
    Wilson IB. Talking with your patients about medication adherence. Script Your Future, http://www.scriptyourfuture.org/medication-adherence-in-practice-webinar/. 2015. Accessed 21 Aug 2017.
  46. 46.
    Steiner JF. Using Adherence Information to Improve Care: From Clinic Visits to Populations. J Gen Intern Med. 2016;31(11):1272-3.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Lester RT, Ritvo P, Mills EJ, et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet. 2010;376(9755):1838-45.Google Scholar
  48. 48.
    Choudhry NK, Bykov K, Shrank WH, Toscano M, Rawlins WS, Reisman L, et al. Eliminating medication copayments reduces disparities in cardiovascular care. Health Aff (Millwood). 2014;33(5):863-70.CrossRefPubMedGoogle Scholar
  49. 49.
    Coca A, Agabiti-Rosei E, Cifkova R, Manolis AJ, Redon J, Mancia G. The polypill in cardiovascular prevention: evidence, limitations and perspective - position paper of the European Society of Hypertension. J Hypertens. 2017;35(8):1546-53.CrossRefPubMedGoogle Scholar
  50. 50.
    Siegel SJ. Extended release drug delivery strategies in psychiatry: theory to practice. Psychiatry. 2005;2(6):22-31.Google Scholar
  51. 51.
    Krumme AA, Isaman DL, Stolpe SF, Dougherty S, Choudhry NK. Prevalence, effectiveness, and characteristics of pharmacy-based medication synchronization programs. Am J Manag Care. 2016;22(3):179-86.PubMedGoogle Scholar
  52. 52.
    Girdish C, Shrank W, Freytag S, et al. The impact of a retail prescription synchronization program on medication adherence. J Am Pharm Assoc (2003). 2017.Google Scholar
  53. 53.
    Choudhry NK, Krumme AA, Ercole PM, et al. Effect of reminder devices on medication adherence: the REMIND randomized clinical trial. JAMA Intern Med. 2017;177(5):624-31.Google Scholar
  54. 54.
    Viswanathan M, Golin CE, Jones CD, et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Annals of internal medicine. 2012;157(11):785-95.Google Scholar
  55. 55.
    Kronish IM, Moise N. In search of a "magic pill" for medication nonadherence. JAMA Intern Med. 2017;177(5):631-2.Google Scholar
  56. 56.
    DeKoekkoek T, Given B, Given CW, Ridenour K, Schueller M, Spoelstra SL. mHealth SMS text messaging interventions and to promote medication adherence: An integrative review. Journal of Clinical Nursing. 2015;24(19–20):2722-35.CrossRefPubMedGoogle Scholar
  57. 57.
    Davidson TM, McGillicuddy J, Mueller M, et al. Evaluation of an mHealth medication regimen self-management program for African American and Hispanic uncontrolled hypertensives. J Pers Med. 2015;5(4):389-405.Google Scholar
  58. 58.
    Kronish IM, Moise N, McGinn T, et al. An electronic adherence measurement intervention to reduce clinical inertia in the treatment of uncontrolled hypertension: the MATCH cluster randomized clinical trial. J Gen Intern Med. 2016;31(11):1294-300.Google Scholar
  59. 59.
    Wilson IB, Laws MB, Safren SA, et al. Provider-focused intervention increases adherence-related dialogue but does not improve antiretroviral therapy adherence in persons with HIV. J Acquir Immune Defic Syndr. 2010a;53(3):338-47.Google Scholar
  60. 60.
    Jones DL, Sued O, Cecchini D, et al. Improving adherence to care among "hard to reach" HIV-infected patients in Argentina. AIDS Behav. 2016;20(5):987-97.Google Scholar
  61. 61.
    Wilson SR, Strub P, Buist AS, et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med. 2010b;181(6):566-77.Google Scholar
  62. 62.
    Adams AS, Uratsu C, Dyer W, et al. Health system factors and antihypertensive adherence in a racially and ethnically diverse cohort of new users. JAMA Intern Med. 2013;173(1):54-61.Google Scholar
  63. 63.
    Horberg MA, Hurley LB, Towner WJ, et al. Determination of optimized multidisciplinary care team for maximal antiretroviral therapy adherence. J Acquir Immune Defic Syndr. 2012;60(2):183-90.Google Scholar

Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Michael J. Stirratt
    • 1
  • Jeffrey R. Curtis
    • 2
  • Maria I. Danila
    • 2
  • Richard Hansen
    • 3
  • Michael J. Miller
    • 4
  • C. Ann Gakumo
    • 5
  1. 1.Division of AIDS Research National Institute of Mental HealthBethesdaUSA
  2. 2.Division of Clinical Immunology and RheumatologyUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Department of Health Outcomes Research and PolicyAuburn University Harrison School of PharmacyAuburnUSA
  4. 4.Department of Pharmaceutical SciencesTexas A&M University Irma Lerma Rangel College of PharmacyCollege StationUSA
  5. 5.Department of Acute, Chronic & Continuing CareUniversity of Alabama at Birmingham School of NursingBirminghamUSA

Personalised recommendations