What We Mean When We Talk About Adherence in Respiratory Medicine

Abstract

Adequate medication adherence is key for optimal benefit of pharmacological treatments. A wealth of research has been conducted to understand and identify opportunities to intervene to improve medication adherence, but variations in adherence definitions within prior research have led to ambiguity in study findings. The lack of a standard taxonomy hinders the development of cumulative science in adherence research. This article reviews the newly established Ascertaining Barriers to Compliance (ABC) taxonomy for medication adherence with a particular focus on its relevance and applicability within the context of asthma and chronic obstructive pulmonary disease management. Building on traditional definitions and concepts within medication adherence, the ABC taxonomy considers the temporal sequence of steps a patient must undertake to be defined as "adherent to treatment": (A) initiation, (B) implementation, and (C) persistence. We explain the clinical and research relevance of differentiating between these phases, point to differences in its applicability in observational and experimental research, review strengths and limitations of available measures, and highlight recent findings on specific determinants of these behaviors. Finally, we provide recommendations for research and practice with a view to supporting and sign posting opportunities to improve future respiratory medication adherence and associated research.

Computation of adherence to medication and visualization of medication histories in R with AdhereR: Towards transparent and reproducible use of electronic healthcare data

“…Yet, it is largely consistent with terms and definitions proposed by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) of initial medication adherence [7], adherence (compliance), and persistence [8]. While these definitions represent a common starting point for adherence studies, their application to particular conditions and medications requires further consideration of specific clinical contexts [9]. ISPOR also provides practical guidance on conducting, reporting and evaluating adherence studies using retrospective databases [4].…”

“…For medications prescribed for limited time (acute care, randomized controlled trials), discontinuation occurs frequently as a single event after which no medication is administered until a clinically-relevant or research-related time point (e.g. the duration considered necessary for clinical benefit); in contrast, for long-term treatment (symptomatic treatment in chronic conditions, preventive long-term regimens), the same medication can be discontinued and re-initiated multiple times [9]. Pharmaco-epidemiologic research uses the concept of treatment episode to denote a period of active medication use: two consecutive medication events are considered to belong to the same episode if the time difference between the start of the second and the end of the supply from the first does not exceed a researcher-defined gap length [12].…”

Factors related to good asthma control using different medical adherence scales in Latvian asthma patients: an observational study

“…13 Vrijens et al’s proposed Ascertaining Barriers to Compliance (ABC) taxonomy conceptualizes adherence to medications in line with principles of behavioral and pharmacological science. 14 The ABC taxonomy defines the overarching concept of “medication adherence” as the process by which patients take their medication as prescribed and subdivides it into 3 essential elements: (A) initiation; (B) implementation, and (C) persistence. This subdivision outlines the sequence of events that have to occur for a patient to experience the optimal benefit from his or her prescribed treatment regimen.…”

“…This subdivision outlines the sequence of events that have to occur for a patient to experience the optimal benefit from his or her prescribed treatment regimen. 14 …”

Important Design Features of Personal Health Records to Improve Medication Adherence for Patients with Long-Term Conditions: Protocol for a Systematic Literature Review (Preprint)

“… Interventions that explore the effect of PHR on medicines adherence [19,20,48], compliance [20,21], persistence [48], and concordance [21];  Interventions that explore how and how much patients use PHRs and the effect this use might have in medicines adherence, compliance, persistence and perceptions;  Interventions that explore the notion of polypharmacy on adult patients with multiple conditions and how PHRs and technology in general may be of assistance.…”