Toward appropriate criteria in medication adherence assessment in older persons: Position Paper

Abstract

Nonadherence to medication regimens is a worldwide challenge; adherence rates range from 38 to 57 % in older populations with an average rate of less than 45 % and nonadherence contributes to adverse drug events, increased emergency visits and hospitalisations. Accurate measurement of medication adherence is important in terms of both research and clinical practice. However, the identification of an objective approach to measure nonadherence is still an ongoing challenge. The aim of this Position Paper is to describe the advantages and disadvantages of the known medication adherence tools (self-report, pill count, medication event monitoring system (MEMS) and electronic monitoring devices, therapeutic drug monitoring, pharmacy records based on pharmacy refill and pharmacy claims databases) to provide the appropriate criteria to assess medication adherence in older persons. To the best of our knowledge, no gold standard has been identified in adherence measurement and no single method is sufficiently reliable and accurate. A combination of methods appears to be the most suitable. Secondly, adherence assessment should always consider tools enabling polypharmacy adherence assessment. Moreover, it is increasingly evident that adherence, as a process, has to be assessed over time and not just at one evaluation time point (drug discontinuation). When cognitive deficits or functional impairments may impair reliability of adherence assessment, a comprehensive geriatric assessment should be performed and the caregiver involved. Finally, studies considering the possible implementation in clinical practice of adherence assessment tools validated in research are needed.

COPD patients’ self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation

“…Regarding adherence, our data are in line with international literature concerning both assessment procedure and results. Despite the well-known limits of adherence assessment by self-report tools, which may overestimate adherence,20 between one-third and one half of our patients report difficulties in adhering to behavioral prescriptions, thus stressing the necessity to intervene specifically on these aspects. Regarding disease perception, one-third of our patients struggle with DA and adaptation as shown in previous studies 33.…”

“…There are many methods to assess adherence; direct (objective physiological/biochemical analysis) or indirect ones (objective monitoring of medication usage or patient’s self-report). Each method has advantages and disadvantages, but no single method is sufficiently reliable and accurate; thus, a combination of assessment methods may be preferred in order to increase validity and reliability of the information collected 20. Moreover, as described in the literature, most of the tools used to assess adherence and the interventions to enhance medication adherence do not focus on behavioral prescriptions, but focus mainly on taking or not taking drugs 7…”

Adherence to the Use of New Oral Anticoagulants in Patients With Atrial Fibrillation – the Way to Solve the Problem of Efficacy and Safety of Treatment

“…Во всех странах больные с ФП сообщали, что режим приема препаратов 1 р/д облегчал выполнение назначений врача. Коморбидность па-циента, несомненно, косвенно влияет на привержен-ность к фармакотерапии из-за возрастающей сложно-сти схемы лечения [60]. Предполагается, что поли-фармация, определяемая как назначение пяти или бо-лее препаратов одновременно для терапии различных заболеваний, снижает приверженность к лечению…”

A technological framework based on automatic messaging for improving adherence of diabetic patients

“…Measuring adherence is complex and, even if widely discussed, there are still no "gold" standards ( (Giardini et al 2015), (Costa et al 2015). …”

“…Figure 9. Determinants of medication adherence (Iuga & McGuire 2014 ((Giardini et al 2015), (Costa et al 2015). …”