A New Taxonomy for Describing and Defining Adherence to Medications

Abstract

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.

Measurement of adherence to BCR-ABL inhibitor therapy in chronic myeloid leukemia: current situation and future challenges

“…60 In the current review, none of the studies assessed adherence to BCR-ABL inhibitors across these different treatment phases.…”

“…[56][57][58][59] A recent publication describing the taxonomy defining adherence to medications, defined this term as the process by which patients take their medication as prescribed, further divided into 3 quantifiable phases: 'initiation', 'implementation' and 'discontinuation'. 60 In the current review, none of the studies assessed adherence to BCR-ABL inhibitors across these different treatment phases.…”

Self-report measures of medication adherence behavior: recommendations on optimal use

“…A scientific consensus group described the primary components of medication adherence as initiation (i.e., starting a recommended medication regimen), implementation (i.e., executing the prescribed dosage schedule), and persistence (i.e., length of time on regimen before discontinuation) [11]. Regimen implementation has been the focus of much research and is commonly defined as the percentage of prescribed medication doses taken over a specific time interval [10].…”

A Case Study Investigation into the Use of Multi-compartment Compliance Aids in Older People Resident in Very Sheltered Housing

“…Medicines adherence, defined as 'the process by which patients take their medicines as prescribed, composed of initiation, implementation and discontinuation' [12], may also be impacted.…”