who definition of adherence

Handbook of Clinical Health Psychology, Vol 2. Long-term care 3. The WHO, in its 2003 report on medication adherence, states that "increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatment" []. Hess LM. Apart from purposefully misleading the system, patients may accidentally actuate the container without taking the medication [15]. and transmitted securely. Haynes RB, McDonald H, Garg AX, Montague P. Interventions for helping patients to follow prescriptions for medications. Issues in adherence with pediatric regimens. For instance, although MEMS is known for its high accuracy, adherence overestimation may still occur when using this method. In that case, persistence is defined as the time from inclusion until discontinuation. It is calculated by the number of days without any medication over number of days in the interval. However, given the widely perceived, negative connotation of (non-) compliance', and its multiple uses (e.g. Even though not all such features are available in all devices, recording adherence performance is essential for analysis and to tailor suitable interventions. Alternatively, questions can also be based on patient's knowledge on the personal prescribed regime, including drugs' name, schedule, and indications. Improving medication adherence is, therefore, crucial and revealed on many studies, suggesting interventions can improve medication adherence. For example, the WHO definition of adherence addresses the need for patients to be involved in treatment decisions. Summary of self-report questionnaire and scales: function(s), target population(s), advantages, and disadvantages. The evolutionary analytic method was used to identify and explore transitions in the concept of adherence over time and across healthcare disciplines. Many patients do not adhere to effective treatments for the preservation of life [4], [5], quality of life [6][8], organs [9] or sight [10], [11], with direct clinical [12], [13] and economic consequences [14], [15]. Compliance, for instance, has been viewed by many as having the negative connotation that patients are subservient to prescribers [41][45]. Often, compliance is also used and the two can be used interchangeably in research and clinical practice [11]. Additionally, drug-drug interactions and drug-food interactions can hinder the assay's accuracy. Kothawala P, Badamgarav E, Ryu S, Miller RM, Halbert RJ. Assessing and achieving readiness to initiate HIV medication. Many authors believe that these subjective methods are the least reliable among all. From Compliance to Concordance: Towards Shared Goals in Medicine Taking. Because of the breadth of the topic and the multiple behaviours that are subsumed under it, no single term (e.g. Careers, Unable to load your collection due to an error. Ho P. M., Bryson C. L., Rumsfeld J. S. Medication adherence: its importance in cardiovascular outcomes. Svarstad B. L., Chewning B. Compliance is the extent to which the patient's behaviour (in terms of taking medications, following diets or executing other lifestyle changes) coincides with the clinical prescription. The site is secure. Adherence to (or compliance with) a medication regimen is generally defined as the extent to which patients take medications as prescribed by their health care providers. Strom O, Borgstrom F, Kanis JA, Jonsson B. The first seven items are Yes/No responses while the last item is a 5-point Likert response. Meta-analysis of medical regimen adherence outcomes in pediatric solid organ transplantation. Despite four decades of adherence research, there is still no uniformity in the terminology used to describe deviation from prescribed regimens. As a measure of reviewing patient's medication-taking behavior and barriers to adherence, Hill-Bone has a limited generalizability since it targets patients with antihypertensive medication only. Federal government websites often end in .gov or .mil. Understanding patients' beliefs and goals in medicine-taking. Lehane E., McCarthy G. Medication non-adherenceexploring the conceptual mire. For successful pharmacotherapy, healthcare professionals and researchers should utilize all available methods within their limits of practice to improve medication adherence. Different tools have been designed and validated for different conditions, in different circumstances. In: Kazarian SS, Evans DR, editors. Modi A. C., Ingerski L. M., Rausch J. R., Glauser T. A., Drotar D. White coat adherence over the first year of therapy in pediatric epilepsy. A representative sample of papers was identified from the disciplines of nursing, medicine, psychology and pharmacy. BV, JD, JU are employees of AARDEX Group SA, Sion, Switzerland. A statement for healthcare professionals. Bond C. Concordance- Is it a synonym for compliance or a paradigm shift? The rationale of ranking can either be determined by clinical outcomes or researcher's expertise. In: Fava GA, Freyberger H, editors. The authors declare that there is no conflict of interests regarding the publication of this paper. 2005. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. However, in the past decade there has been substantial growth in adherence research, partly owing to increasing awareness of the size and scope of the problem, partly because of the pervasiveness of non-adherence across all therapeutic fields and partly because of its potentially large contribution to the overall variance in drug responses. Discontinuation marks the end of therapy, when the next dose to be taken is omitted and no more doses are taken thereafter. An official website of the United States government. The term Patient compliance was introduced in 1975 as an official Medical Subject Heading (MeSH) in the US National Library of Medicine [66], [67]. It is also understood that patients who are prescribed medications do not necessarily take them as prescribed. However, the definitions of these terms are unsatisfactory [109], [110], as they are used interchangeably but inconsistently to define variation or uncertainties in the linkages between seeking medical attention, acquiring prescriptions [111], and deviating from the administration of medicines as prescribed [112][114]. Concordance: what is the relevance for pharmacists? In: Racsynski JM, editor. In summary, subjective and objective measures have both advantages and disadvantages and should be used in combination. Its estimation can range from a single summary statistic to a more longitudinal comparison. Nonadherence may limit the benefits of medicines, resulting in lack of improvement, or deterioration, in health. Meanwhile, researches on improving the currently available measures and/or on the development of new ways to measure and uncover reasons behind medication nonadherence should also be further explored. This review defined medication-taking behaviors as any missing dose taken, as well as frequency on prescription refill while barriers to adherence were defined as tendency to forget, disease-specific reasons, regime complexity, and/or side effect of prescribed medications. In 1997 the American Heart Association issued a statement [92] in which adherence was defined as a behavioural process, strongly influenced by the environment in which the patient lives, including health care practices and systems [93], [94]. Interventions for enhancing medication adherence. Our approach has integrated findings from different initiatives while remaining independent of any measurement method. Therefore, in this paper, adherence will mainly be used. The taxonomic approach was subsequently re-evaluated in light of the identified papers and refined in JuneAugust 2009. Vermeire E, Hearnshaw H, Van RP, Denekens J. 8600 Rockville Pike Adherence to medication is a crucial part of patient care and indispensable for reaching clinical goals. Health behavior 6. Toward a standard definition and measurement of persistence with drug therapy: examples from research on statin and antihypertensive utilization. A total of USD$274 per patient was required to complete a 6-month study in a 2001 study that estimated medication adherence in patients with schizophrenia or schizoaffective disorder [23]. 'Adherence to medications' is the process by which patients take their medication as prescribed, further divided into three quantifiable phases: 'Initiation', 'Implementation' and 'Discontinuation'. The most common drawback is that patients tend to underreport nonadherence to avoid disapproval from their healthcare providers [19]. Keeling A, Utz SW, Shuster GF, III, Boyle A. Noncompliance revisited: a disciplinary perspective of a nursing diagnosis. It was designed and first validated for patients with schizophrenia [52]. For instance riboflavin, a biological marker, is simply nonquantitative for detection [23]. The internal consistency reliability of MARS is unclear [4]. Llabre M. M., Weaver K. E., Durn R. E., Antoni M. H., McPherson-Baker S., Schneiderman N. A measurement model of medication adherence to highly active antiretroviral therapy and its relation to viral load in HIV-positive adults. Sub-optimal adherence to prescribed medicines is frequently the principal obstacle to successful pharmacotherapy in ambulatory patients, especially when it is unrecognized clinically, as often occurs. Currently a number of terms, e.g. It describes the extent to which the patients' behavior (including medication-taking) coincides with medical or healthcare advice [12], yet its meaning has become more negative regarding patient's behaviors, since it implies patient's passivity [13]. In a broad sense, subjective and objective measures are preferred in clinical and research settings, respectively, mainly due to cost effectiveness ratios. Differences in cardiovascular disease risk when antihypertensive medication adherence is assessed by pharmacy fill versus self-report: the Cohort Study of Medication Adherence among Older Adults (CoSMO). Based on the MAQ, Morisky et al. 2001. What do we mean by adherence to treatment and advice for living with diabetes? It should provide researchers and clinicians with a common language for describing different experimental investigations. HIV. Lahdenper T, Kyngs H. Compliance and its evaluation in patients with hypertension. Therefore, utilizing the database for refill adherence is intended for consistent, nondiscretionary use. Chisholm-Burns MA, Spivey CA. Gray R, Wykes T, Gournay K. From compliance to concordance: a review of the literature on interventions to enhance compliance with antipsychotic medication. An official website of the United States government. Primary nonadherence is the frequency with which patients fail to fill prescriptions when new medications are started so it is related to refilling and initiation of the medication therapy [9]. Persistence is the time from initiation until discontinuation. The definition of correct is ambiguous in the reviewed papers, because there are certain scientific aspects of when and how much of certain drugs should be taken that are not negotiable if the prescribed medicine is to work satisfactorily, e.g. A majority (77%) agreed with the proposed taxonomy and 72% also agreed with the proposed terminology; 15% were not sure about the proposal. Reviewing prescription refill records requires a centralized computerized system along with a consistency among prescribers and dispensers to collect a complete dataset over that designated period [15]. However, even after decades of research, there is very little guidance for healthcare professionals and researchers to choose the most suitable adherence measures. However, limited knowledge exists regarding the underlying mechanisms of this . Education, psychology and compliance. For example, the three patients illustrated in Figure 5 all took 75% of their prescribed twice daily doses over a period of 3 months. Mitchell AJ. Impact of postal and telephone reminders on pick-up rates of unclaimed e-prescriptions. Global Adherence Interdisciplinary Network. These measures can be made randomly or at specific intervals [15]. However, overestimation is very common and an average of 30% surplus of diary entries has been shown to occur when comparing with different results from MEMS data [15]. Patient adherence to treatment: three decades of research. An individual tool can only detect patients with low to moderate level of adherence. Management of adherence and chronic rheumatic disease in children and adolescents. Hughes CM. Received 2015 May 13; Revised 2015 Jul 31; Accepted 2015 Aug 5. Vrijens B, Urquhart J. On white-coat effects and the electronic monitoring of compliance. Inaccurate estimation of medication adherence can lead to several problems which are potentially costly and dangerous in both settings. Interest in patient adherence has increased in recent years, with a growing literature that shows the pervasiveness of poor adherence to appropriately prescribed medications. From compliance to concordance in diabetes. adherence meaning: 1. the act of obeying a set of rules or principles 2. someone who obeys a particular set of rules. 2. Adherence presumes an agreement between prescriber and patient about the prescriber's recommendations. No additional information was sought from the authors. Culig J., Leppe M. From Morisky to Hill-bone; self-reports scales for measuring adherence to medication. Sodergard B, Hofer S, Halvarsson M, Sonnerborg A, Tully MP, Lindblad AK. Most commonly, it refers to medication or drug compliance, but it can also apply to other situations such as medical device use, self care, self-directed exercises, or therapy sessions . Medication adherence in patients who have heart failure: a review of the literature. . FOIA Studies have shown that medication literacy has a positive effect on medication adherence in patients with multimorbidity. As such, objective measures should be used to validate and correlate the subjective ones. In turn, this quantification informs the process of managing adherence, the aim of which is to help patients to take appropriately prescribed drug dosing regimens. The concept of concordance and its relation to leg ulcer management. Compliance is futile but is concordance between rheumatology patients and health professionals attainable? We hope that the proffered taxonomy will stimulate discussion, informed by shared concepts, methods and research findings. Urquhart J. Pharmionics: research on what patients do with prescription drugs. Moreover, adherence underestimation occurs frequently, since this method simply uses the dispensed date as the denominator of the equation without considering the chance of having surplus medication. Definitions of adherence "Compliance", "adherence", "persistence", and "concordance" are terms related to the suboptimal taking of medicine by patients. Concordance, cooperation, agreement and therapeutic alliance imply a certain meeting of the minds/perspectives of carers/caregivers and patients [100][105] regarding a treatment plan suitable for a course of pharmacotherapy, during which the patients and/or carers/caregivers bear the responsibility for correct administration of the medicine(s) [106][108]. DiMatteo M. R., Giordani P. J., Lepper H. S., Croghan T. W. Patient adherence and medical treatment outcomes: a meta-analysis. Urquhart J, Vrijens B. Taxonomy of patient compliance-related events in drug trials. According to WHO, there are multiple factors leading to poor medication adherence, normally classified into five categories: socioeconomic factors, therapy-related factors, patients-related factors, condition-related factors, and health system/health care team- (HCT-) related factors [1]. Changes in terminology. Assessing medication adherence simultaneously by electronic monitoring and pill count in patients with mild-to-moderate hypertension. We searched MEDLINE, EMBASE, CINAHL, the Cochrane Library and PsycINFO from database inception to 1 April 2009 for all papers addressing the taxonomy/terminology used to describe deviations from prescribed drug treatment in ambulatory patients. CMA is calculated as the cumulative days' supply obtained over a series of intervals divided by the total days from the beginning to the end of the time period in study. Rachid A. In December 2009, a first report on the new taxonomy was submitted to the EU Commission. in many different medical and peri-medical contexts, its use should fade out over time. A., Scheyer R. D., Mattson R. H. Compliance declines between clinic visits. . Twenty-five % were clinically qualified as medical doctors, 30% as pharmacists, and 5% as nurses. Initial searching identified 3121 papers. The WHO, in its 2003 report on medication adherence, states that increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatment [1]. indicated that by its ability to combine identification of the causes behind nonadherence and subsequent intervention, motivational interviewing outperforms the traditional advice giving [43]. However, four decades of adherence research has not resulted in uniformity in the terminology used to describe deviations from prescribed therapies. Bell JS, Airaksinen MS, Lyles A, Chen TF, Aslani P. Concordance is not synonymous with compliance or adherence. 9241545992.pdf (1.541Mb) . As a result, MMAS-8 has become more popular than MAQ. Moreover, the quantification itself can be difficult. Accessibility Therefore, while choosing which measures should be included, researchers should take potential errors, ability to overcome the precedent disadvantages, and practicality to be performed in the target population into consideration. Facilitating Treatment Adherence: A Practioner's Guidebook. Kim M. T., Hill M. N., Bone L. R., Levine D. M. Development and testing of the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Cals JW. The main search terms used were Patient compliance and Medication adherence. Accessibility Frequency histogram presenting the evolution over time of the main terms used among the 146 papers to describe deviations from prescribed treatments. Effective treatments may be judged as ineffective, expensive diagnostic procedures may be ordered, and therapy may be unnecessary and dangerously intensified. However, a meta-analysis on adherence outcomes states that a multi-subjective-measure approach may have higher sensitivity, but not accuracy, over employing a single objective measure [20]. Donovan JL, Blake DR. Compliance may be defined as the extent to which the patient's behaviour matches the prescriber's recommendations . During the meeting, 40 attendees participated in the electronic voting on a consensus on taxonomy in the field of deviations from prescribed treatment. During the meeting the draft consensus document was presented and extensively discussed. Tan X., Patel I., Chang J. Estimating medication persistency using administrative claims data. Medical regimen adherence: concepts, assessments, and interventions. usually + to. More longitudinal comparisons which make clear distinctions between initiation, implementation, and discontinuation have been proposed, as illustrated previously using a large database of electronically compiled drug dosing histories among patients with hypertension [132]. Trostle JA. During the European consensus meetings, issues regarding translation into German, French, Polish and Dutch have been discussed. Operational definitions for the implementation of a dosing regimen should be drug- and disease-specific. 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. There is, however, a clear need to create a set of rules, agreed upon, within which future activities should fit, if all are committed to fulfilment of the need for clear, concise and adequate definitions and an associated conceptual framework, within which work can continue. Velligan DI, Lam YW, Glahn DC, Barrett JA, Maples NJ, Ereshefsky L, Miller AL. Fine RN, Becker Y, De GS, Eisen H, Ettenger R, Evans R, Rudow DL, McKey D, Neu A, Nevins T, Reyes J, Wray J, Dobbels F. Nonadherence consensus conference summary report. The quantification of implementation requires the comparison of two time-series: the prescribed drug dosing regimen and the patient's drug dosing history. It consists of 10 questions with a simple scoring to evaluate patient's adherence behaviour, attitude towards medication, and general disease control during the past week [52]. Aronson JK. further reviewed that, with its ability to allow self-administration, evaluate multidrug regimens, and reduce practitioner's training, this questionnaire is popular among healthcare professionals [5]. Using the health belief model to predict initial drug therapy defaulting. Bernardini J. Ideally, healthcare professionals should not inform patients of the visit's date to minimize this barrier, yet it challenges the right of patients to control their own treatment [26]. Adherence to Long-Term Therapies: Evidence for Action. Poor medication adherence has multifactorial causes that need to be understood before interventions can be designed to improve medication adherence [2]. Farmer has divided refill adherence into 3 types: continuous variable, which is assessed from the first to the last prescription record, such as the Medication Possession Ratio (MPR); dichotomous variable, in which patients are categorized as either compliant or noncompliant based on criteria such as a specified treatment gap; and examining the time between prescription refills from the perspective of time gaps (periods of nonadherence) or consumption (medication availability, the days' supply/days between refills), for example, Continuous Measure of Medication Acquisition (CMA), Continuous Measure of Medication Gaps (CMG), Continuous, Single Interval Measure of Medication Acquisition (CSA), and Continuous, Single Interval Measure of Medication Gaps (CSG)[15]. A quarter century of research. 4. Most analyzed scales have a recommended cutoff value. We prefer the term adherence to medication, but the two terms can be used interchangeably. WHO reported that adherence among patients with chronic diseases averages only 50% in developed countries. Further details will be individually discussed below. While choosing a suitable approach, researchers and healthcare professionals should balance the reliability and practicality, especially cost effectiveness, for their purpose. Medication adherence is defined by the World Health Organization as "the degree to which the person's behavior corresponds with the agreed recommendations from a health care provider." 1 Though the terms adherence and compliance are synonymously used adherence differs from compliance. Cleemput I, Kesteloot K, DeGeest S. A review of the literature on the economics of noncompliance. Hess et al. Hence, this scale is limited to use in patients with chronic mental illness. Blackwell B. Anthonisen NR. Medication non-adherence in the elderly: how big is the problem? However, there is no single measure that can meet all these gold standards since each has its own drawbacks as described above. This element includes the disciplines that seek understanding of the causes or consequences of differences between the prescribed (i.e. sharing sensitive information, make sure youre on a federal Adherence definition: Adherence is the fact of adhering to a particular rule, agreement, or belief. Nonadherence to treatment. Poor medication adherence is a key hindrance in combating the challenges of public health in both developed and developing countries. Lee J. Y., Kusek J. W., Greene P. G., et al. Adherence to long-term therapies: evidence for action. This initial research was triggered by the potential clinical consequences of patient non-adherence and their impact on the results of clinical trials. Adherence to medication is a crucial part of patient care and indispensable for reaching clinical goals. Hudson M, Rahme E, Richard H, Pilote L. Comparison of measures of medication persistency using a prescription drug database. The term pharmionics, introduced in 1987, is defined as the discipline that studies how ambulatory patients use and misuse prescription drugs [68][70]. ns, d- / Add to word list the obeying of a rule or law: He insists upon adherence to every rule, no matter how silly. The most commonly cited text for the definition of patient compliance is a 1976 paper by Sackett & Haynes [64]. Nevertheless, measurement of medication adherence can be quite challenging since and parameters of acceptable adherence need to be carefully delineated and appropriated for individual situations [17]. adherence to religious laws. Can a teaching and learning perspective deepen understanding of the concept of compliance? An ideal medication adherence measure should present low cost and be user friendly, easy to carry out, highly reliable, flexible, and practical [13, 15]. the fact of someone behaving exactly according to rules, beliefs, etc. Elliott R. Non-adherence to medicines: not solved but solvable. Sawyer SM, Aroni RA. Dracup KA, Meleis AI. The Medication Events Monitoring System (MEMS) is the most commonly used EMP device in medication adherence studies. Beyond compliance is adherence. However, the proposed taxonomy forms the cornerstone for concise adherence measurement and facilitates a smooth transition from conceptual to operational definitions. Objective measures provide more accurate data on how patients perform in their medication regimes. This problem is further compounded by a lack of congruence between conceptual definitions, operational definitions and measurements [20], [138][142]. 1. Based on Haynes's early empirical definition of sufficient adherence to antihypertensive medications as taking 80% of medication, many researchers used this threshold to distinguish adherent from non-adherent patients. Indeed, variation in patients' medicat Adherence research has also been spurred by improved methods for compiling dosing histories in ambulatory patients, recognition of the importance of adherence to treatment outcomes in HIV-AIDS, increasing sizes of study populations, and lengthening periods of observation. Furthermore, direct measures are very expensive and difficult to perform as many technicians and professionals are required to monitor the process and carry out the tests. The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review. The WHO defines adherence as the extent to which the persons' behavior (including medication-taking) corresponds with agreed recommendations from a healthcare provider [1]. Cramer J. A comparison study of multiple measures of adherence to HIV protease inhibitors. 8600 Rockville Pike A European consensus meeting, attended by 80 participants from 13 different countries, was organized jointly with the European Society for Patient Adherence, Compliance and Persistence (ESPACOMP) in Bangor, Wales, UK on 1011 September, 2009. It calculates nonadherence values for cumulative periods without considering the possibility of early refill or overfill. Working to increase access to essential pharmaceuticals while . As a result, it is able to examine medication-taking behaviors and attitudes toward medication with higher validity and reliability values. O'Brien MK, Petrie K, Raeburn J. Adherence to medication regimens: updating a complex medical issue. ISBN 92 4 154599 2 (NLM classification:W 85) If researchers and healthcare professionals are looking for measures for a specific or rare condition, they should refer to studies that have a clearer validation. For example, concordance and therapeutic alliance are elements of the management of the adherence process while pharmionics is an adherence related science. Dr Jeffrey Aronson (University of Oxford, UK) chaired the session and supervised the interactive discussion with the participants. (Definition of adherence from the Cambridge Academic Content Dictionary Cambridge University Press) Checchi K. D., Huybrechts K. F., Avorn J., Kesselheim A. S. Electronic medication packaging devices and medication adherence: a systematic review. The process by which patients take their medications as prescribed, composed of. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. This paper reviews both subjective and objective medication adherence measures, including direct measures, those involving secondary database analysis, electronic medication packaging (EMP) devices, pill count, and clinician assessments and self-report. Both facets need to be addressed simultaneously to solve this important health care problem. View/ Open. Rather it is focused on the different types available and the most commonly used in different settings. Currently none of the available methods can be considered as a gold standard and the combination of methods is recommended [15]. From compliance to alliance. Even though direct measures are considered to be the most accurate and can be used as a physical evidence to prove that the patient has taken the medication, there are many drawbacks regarding their use. Compliance becomes concordance. It is based on the Drug Attitude Inventory (DAI), a common psychiatric adherence survey. Consequently, overestimated adherence values are found while using this method. The closed question format with yes-saying bias allows disclosures of nonadherence [44].

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