A new taxonomy for describing and defining adherence to medications
Open accessAbstract
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.
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The review used a methodologically rigorous approach informed by standardized adherence metrics.
“Lastly, we used a methodologically rigorous approach informed by standardized adherence metrics,3,4 conducted quality assessments via JBI critical appraisal checklist,19 and restricted the meta-analyses to fully reported studies, with sensitivity analyses to ensure robustness.”
From Adherence to PCSK9 Inhibitors in Clinical Practice (2026) · cites this paper as [4]
Clinical challenges are compounded by methodological issues in adherence research, particularly wide variability in how adherence implementation, persistence, and discontinuation are defined and measured.
“These clinical challenges are compounded by methodological issues in adherence research—particularly the wide variability in how adherence implementation, persistence, and discontinuation are defined and measured.4”
From Adherence to PCSK9 Inhibitors in Clinical Practice (2026) · cites this paper as [4]
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- Authors
- Vrijens, B., De Geest, S., Hughes, D. A., Przemyslaw, K., Demonceau, J., Ruppar, T., Dobbels, F., Fargher, E., Morrison, V., Lewek, P., Matyjaszczyk, M., Mshelia, C., Clyne, W., Aronson, J. K., Urquhart, J., & for the ABC Project Team
- Affiliations
- University of Liège (BE)
- Bangor University (GB)
- University of Missouri (US)
- KU Leuven (BE)
- Keele University (GB)
- University of Oxford (GB)
- University of California, San Francisco (US)
- Corresponding author
- Vrijens, Bernard
- ORCID
- Venue
- British Journal of Clinical Pharmacology
- Publisher
- Wiley
- Published
- 2012-04-05
- Volume
- 73
- Issue
- 5
- Pages
- 691-705
- ISSN
- 0306-5251 (ISSN-L)
- 1365-2125
- PMC
- PMC3403197
- OpenAlex
- W1741567663
- Cited by
- 2,028
- References
- 147
- Citations by year
- 2026: 170 · 2025: 195 · 2024: 238 · 2023: 190 · 2022: 192 · 2021: 196 · 2020: 182 · 2019: 156 · 2018: 144 · 2017: 141 · 2016: 75 · 2015: 59 · 2014: 39 · 2013: 42 · 2012: 9
- FWCI
- 6.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Clinical Pharmacology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Lirias (KU Leuven) (submittedVersion, other-oa)
- ORBi (University of Liège) (submittedVersion, other-oa)
- PEARL (University of Plymouth) (submittedVersion)
- PEARL (University of Plymouth) (submittedVersion, other-oa)
- edoc (University of Basel) (submittedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
- Funders
- European Commission (FP7/2007, 223477)
- School of Medicine, Stanford University
- Belgian Health Care Knowledge Centre
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- medication adherence, terminology standardization, medication-taking behavior
- MeSH terms
- Pharmaceutical Preparations, Humans, Patient Care Management, Databases, Factual, Drug Monitoring, Disease Management, Medication Adherence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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