Adherence to medication is a vital aspect of patient care and important for achieving clinical goals. The WHO has recorded that in developing countries, adherence among patients with chronic diseases averages just 50 percent. As medication non-adherence contributes to poor health outcomes and increased healthcare costs, this is recognised as a major public health concern. Improving adherence to medication is therefore important and revealed in several studies, indicating that interventions can enhance adherence to medication. Knowing its magnitude is one critical part of the techniques to strengthen drug adherence. However, in order to orchestrate subsequent interventions, there is a lack of general guidelines for researchers and healthcare professionals to choose the best instruments that can investigate the level of medication adherence and the reasons behind this issue. This paper reviews both subjective and quantitative adherence measures to medication, including direct measures, those requiring secondary examination of databases, devices for electronic medication packaging (EMP), pill count, observations of clinicians and self-reports. In general, subjective measures offer reasons for patient non-adherence, while quantitative measures lead to a more reliable record of the actions of patients taking medication. Researchers and healthcare professionals should balance reliability and practicality, especially cost-effectiveness, for their purposes, when selecting an appropriate approach. Meanwhile, since there is no perfect measure, the best solution actually seems to be a multi-measure approach. This research should be able to provide clinicians with a general direction for selecting the most appropriate steps for their priorities and then providing reliable, personalised approaches to change the conduct of patients taking medication.
Wai Yin Lam
UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, United Kingdom.
Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal.
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