Interest in patient adherence has increased in recent years, with a growing literature that shows the pervasiveness of poor adherence to appropriately prescribed medications. However, four decades of adherence research has not resulted in uniformity in the terminology used to describe deviations from prescribed therapies. The aim of this review was to propose a new taxonomy, in which adherence to medications is conceptualized, based on behavioural and pharmacological science, and which will support quantifiable parameters. A systematic literature review was performed using MEDLINE, EMBASE, CINAHL, the Cochrane Library and PsycINFO from database inception to 1 April 2009. The objective was to identify the different conceptual approaches to adherence research. Definitions were analyzed according to time and methodological perspectives. A taxonomic approach was subsequently derived, evaluated and discussed with international experts. More than 10 different terms describing medication-taking behaviour were identified through the literature review, often with differing meanings. The conceptual foundation for a new, transparent taxonomy relies on three elements, which make a clear distinction between processes that describe actions through established routines ('Adherence to medications' , 'Management of adherence') and the discipline that studies those processes ('Adherence-related sciences'). 'Adherence to medications' is the process by which patients take their medication as prescribed, further divided into three quantifiable phases: 'Initiation' , 'Implementation' and 'Discontinuation' . In response to the proliferation of ambiguous or unquantifiable terms in the literature on medication adherence, this research has resulted in a new conceptual foundation for a transparent taxonomy. The terms and definitions are focused on promoting consistency and quantification in terminology and methods to aid in the conduct, analysis and interpretation of scientific studies of medication adherence.

Interest in patient adherence has increased in recent years, with a growing literature that shows the pervasiveness of poor adherence to appropriately prescribed medications. However, four decades of adherence research has not resulted in uniformity in the terminology used to describe deviations from prescribed therapies. The aim of this review was to propose a new taxonomy, in which adherence to medications is conceptualized, based on behavioural and pharmacological science, and which will support quantifiable parameters. A systematic literature review was performed using MEDLINE, EMBASE, CINAHL, the Cochrane Library and PsycINFO from database inception to 1 April 2009. The objective was to identify the different conceptual approaches to adherence research. Definitions were analyzed according to time and methodological perspectives. A taxonomic approach was subsequently derived, evaluated and discussed with international experts. More than 10 different terms describing medication-taking behaviour were identified through the literature review, often with differing meanings. The conceptual foundation for a new, transparent taxonomy relies on three elements, which make a clear distinction between processes that describe actions through established routines ('Adherence to medications' , 'Management of adherence') and the discipline that studies those processes ('Adherence-related sciences'). 'Adherence to medications' is the process by which patients take their medication as prescribed, further divided into three quantifiable phases: 'Initiation' , 'Implementation' and 'Discontinuation' . In response to the proliferation of ambiguous or unquantifiable terms in the literature on medication adherence, this research has resulted in a new conceptual foundation for a transparent taxonomy. The terms and definitions are focused on promoting consistency and quantification in terminology and methods to aid in the conduct, analysis and interpretation of scientific studies of medication adherence.

No abstract

The results of this review provide a foundation for the development of theory-led adherence-enhancing interventions that could promote sustainable behavior change in clinical practice.

Accepting that opioid use and crime are associated and develop together, amongst opioid-using criminals the need for opioids may cause crime on a day-to-day basis or both may tend to be determined by some other set of factors. Previous studies have either failed to allow for such other factors, or have failed to compare opioid users to adequate control groups. From interviews with 151 Scottish prisoners and non-prisoners, divided into five drug-using groups: (1) alcohol only; (2) cannabis and alcohol; (3) other drugs but not opioids; (4) moderate opioids; (5) heavy opioids, data were obtained on drug use frequency, crime frequency and a variety of other variables. It was found that: (1) there were no differences between incarcerated and non-incarcerated opioid users, in fact incarceration had no substantial effects on other variables; (2) heavy opioid users committed crimes significantly more frequently than did moderate opioid users, non-opioid polydrug users, cannabis users or alcohol users. But, moderate opioid users did not commit crimes significantly more frequently than did the other groups; (3) other drugs were related to crime. Polydrug use (including cannabis use) was more related to theft and delinquency than was opioid use. Alcohol use was related to fraud; (4) there were larger explanations of crime than opioid use--criminal experience and polydrug use--and crime was a better explanation of opioid use variance than opioid use was of crime. It is concluded that need for opioids did not simply cause crime. Rather, crime and opioid use tended to influence each other. However, this relationship was not special to opioids but, depending on historical circumstances, could--and to some extent does--apply to any drug. In consequence, society's treatment of drug-using criminals needs to deal with drug use and crime together.