The myths of medication adherence

Gellad, Walid F.; Thorpe, Carolyn T.; Steiner, John F.; Voils, Corrine I.

doi:10.1002/pds.4334

Cited by 66 publications

(50 citation statements)

References 32 publications

(68 reference statements)

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“…(10) Unfortunately, inadequate research reporting often hampers interpretation of findings, complicates data abstraction for meta-analyses and prevents study replication. Common problems of reporting include unclear, inconsistent definitions; (11)(12)(13)(14) inadequate measurement of adherence outcomes; (7,14,15) suboptimal methods of analysis; (11)(12)(13)(14) insufficiently detailed descriptions of intervention delivery settings; (15) and scant theoretical underpinnings. (16) Previous efforts to improve adherence research reporting standards (11,(17)(18)(19)(20), adherence research, (17,19) include no clear conceptualization of medication adherence (11,17,19,20) and focus on research methods rather than reporting.…”

Section: Challenges and Shortcomings In Medication Adherence Reportingmentioning

confidence: 99%

ESPACOMP Medication Adherence Reporting Guideline (EMERGE)

et al. 2018

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Research on assessing or managing medication adherence applies approaches from observational, interventional, and implementation science that spans many disciplines and demands coherent conceptualization, valid methods, appropriate analyses, and complete and accurate reporting. To ensure such reporting, the European Society for Patient Adherence, COMpliance, and Persistence (ESPACOMP) Medication Adherence Reporting Guideline (EMERGE) recommends standard reporting approaches based on an accepted taxonomy. This guideline is derived from a literature review, a reactive Delphi study with 26 medication adherence experts from many countries and disciplines, and feedback from ESPACOMP members. It is designed to supplement existing guidelines for health research reporting and is structured around 4 minimum reporting criteria and 17 items reflecting best reporting practice. By enhancing and harmonizing research reporting, EMERGE aims to advance research and, ultimately, patient outcomes.

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Section: Challenges and Shortcomings In Medication Adherence Reportingmentioning

confidence: 99%

ESPACOMP Medication Adherence Reporting Guideline (EMERGE)

et al. 2018

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“…Ten studies used pre-defined thresholds from prior research studies, while only five studies derived the adherence threshold from their studies' cohort percentiles or data distributions. Often, a threshold of 0.80 has been regarded as adequate adherence and has been applied in policy as a quality measure [61]. However, this threshold can differ by disease state [62], patient outcome of interest [63], and patient's health status [64], within the same study cohort.…”

Section: Discussionmentioning

confidence: 99%

Refill Adherence Measures and Its Association with Economic, Clinical, and Humanistic Outcomes Among Pediatric Patients: A Systematic Review

Chua

Morgan

Yap

2020

IJERPH

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Although refill adherence measures (RAMs) are widely reviewed on their use among adult patients, existing reviews on adherence among children have only focused on self-report measures and electronic monitoring. Hence, this systematic review aims to examine the use of RAMs and their association with economic, clinical, and humanistic outcomes (ECHO) among pediatric patients. A literature search was conducted in Pubmed, Embase, CINAHL, and PsycINFO. Studies published in English involving subjects aged ≤18 years were included if RAMs were analyzed with ECHO. Of the 35 included studies, the majority (n = 33) were conducted in high-income countries. Asthma was the most common condition (n = 9) studied. Overall, 60.6% of 33 clinical outcomes reported among 22 studies was positive (improved clinical outcomes with improved adherence), while 21.9% of 32 economic outcomes reported among 16 studies was positive (reduced healthcare utilization or cost outcomes with improved adherence). Only four studies evaluated the relationship of adherence with 11 humanistic outcomes, where the majority (72.7%) were considered unclear. RAMs are associated with ECHO and can be considered for use in the pediatric population. Future studies could explore the use of RAMs in low-income countries, and the association of RAMs with quality of life.

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“…While there are no formal recommendations for the definition of non-adherence, a threshold of <80% is often regarded as poor adherence [17]. However, higher MPR thresholds may be required, depending on the condition, medication, or patient populations [18,19]. For example, a threshold of 95% has been set for antiretroviral therapy due to its association with maximal viral load suppression and minimal opportunistic infection [20].…”

Section: Discussionmentioning

confidence: 99%

“…Third, insulin adjustments which may follow different diet plans, and involvement of caregivers were not accounted for in the present study. Since MPR measures only a single adherence behavior in the implementation phase of adherence time continuum [18], patientreported measures such as the Diabetes Self-Management Profile and diabetes self-care activities can be used concurrently with pharmacy refill records to provide holistic insights into non-adherent behaviors.…”

Section: Discussionmentioning

confidence: 99%

Adherence to Insulin in Singaporean Pediatric Type 1 Diabetes Patients and Its Impact on Glycemic Control and Health-Care Utilization

Chua¹,

Lim²,

Poh³

et al. 2019

Asian J Pharm Clin Res

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Objective: Optimizing glycemic control is challenging with insulin non-adherence. This study aimed to characterize the prevalence of non-adherence among Singaporean pediatric patients with type 1 diabetes mellitus (T1DM) and investigate its associated outcomes. Methods: Singaporean patients with T1DM aged ≤18 years old with ≥1 year of insulin prescription between 2012 and 2016 were included in this retrospective, single-center longitudinal study. Patients on insulin pumps were excluded from the study. Non-adherence was defined as medication possession ratio (MPR) <100%. Glycemic control was defined using mean hemoglobin A1c (HbA1c) within the study period. Health-care utilization was defined as the number of outpatients, inpatient, and emergency visits. The t-test, Chi-square test, logistic regression, and Poisson regression were used to analyze means, proportions, factors associated with non-adherence, and association of non-adherence and health-care utilization, respectively. Sensitivity analyses were performed for MPR thresholds of 80% and 95%. Results: A total of 206 patients were included in this study. Non-adherent patients were older, had a longer duration of diabetes since diagnosis and shorter duration of follow-up. Gender, race, financial class, and number of concurrent medications were comparable between groups. The prevalence of non-adherence was 34.0% (95% confidence interval [CI]: 27.9–40.7%). Non-adherent patients had a higher average HbA1c (non-adherent: 9.6% [2.1] vs. adherent: 8.6% [1.3], p<0.001). Non-adherence was not associated with health-care utilization. Patients with >5 years of diabetes were more likely to be non-adherent. Conclusion: Non-adherence defined as MPR <100% is associated with poorer glycemic control. Further interventions may focus on patients with >5 years of diabetes to improve their adherence to insulin therapy.

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The myths of medication adherence

Cited by 66 publications

References 32 publications

ESPACOMP Medication Adherence Reporting Guideline (EMERGE)

ESPACOMP Medication Adherence Reporting Guideline (EMERGE)

Refill Adherence Measures and Its Association with Economic, Clinical, and Humanistic Outcomes Among Pediatric Patients: A Systematic Review

Adherence to Insulin in Singaporean Pediatric Type 1 Diabetes Patients and Its Impact on Glycemic Control and Health-Care Utilization

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