Medication adherence measures: An overview
Open accessAbstract
WHO reported that adherence among patients with chronic diseases averages only 50% in developed countries. This is recognized as a significant public health issue, since medication nonadherence leads to poor health outcomes and increased healthcare costs. Improving medication adherence is, therefore, crucial and revealed on many studies, suggesting interventions can improve medication adherence. One significant aspect of the strategies to improve medication adherence is to understand its magnitude. However, there is a lack of general guidance for researchers and healthcare professionals to choose the appropriate tools that can explore the extent of medication adherence and the reasons behind this problem in order to orchestrate subsequent interventions. 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. Subjective measures generally provide explanations for patient's nonadherence whereas objective measures contribute to a more precise record of patient's medication-taking behavior. While choosing a suitable approach, researchers and healthcare professionals should balance the reliability and practicality, especially cost effectiveness, for their purpose. Meanwhile, because a perfect measure does not exist, a multimeasure approach seems to be the best solution currently.
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The predominance of indirect measures could be due to the accessibility of pharmacy data and the objectivity of this metric, making indirect measures ideal for clinical research.
“This could be due to the accessibility of pharmacy data and the objectivity of this metric, making indirect measures ideal for clinical research.61”
From Interventions to improve adherence to lipid-lowering drugs: a systematic review and meta-analysis (2025) · cites this paper as [61]
Section 4 (page unavailable) says prescription-refill records are popular in research because they permit analysis of large populations, but obtaining a complete dataset requires a centralized computerized system and consistent records. Section 8 (page unavailable) favors pharmacy-refill measures for large research populations when balancing accuracy and cost. The paper does not say pharmacy data are generally accessible or that all indirect measures are ideal for clinical research. (LLM, conf=0.85)
Experimental — accuracy not yet measuredCut-off values for distinguishing adherence from non-adherence are often arbitrary, leading to recommendations that research should use continuous rather than dichotomous measures.
“However, the o en arbitrary cut-off values for distinguishing 'adherence' from 'non-adherence' (Lam 2015) has led to recommendations that research should use measures that are continuous rather than dichotomous (DiMatteo 2002).”
From Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (2023) · cites this paper as Lam 2015
Subjective measures are subject to the patient's psychological state, interviewer's communication skills, and design of questionnaires.
“Such measures are subject to the patient's psychological state, interviewer's communication skills, and design of questionnaires.61”
From Interventions to improve adherence to lipid-lowering drugs: a systematic review and meta-analysis (2025) · cites this paper as [61]
While less reliable in the research setting, subjective measures can offer practical insights to barriers to adherence to facilitate tailoring interventions to a specific patient.
“While less reliable in the research setting, subjective measures can offer practical insights to barriers to adherence to facilitate tailoring interventions to a specific patient.61”
From Interventions to improve adherence to lipid-lowering drugs: a systematic review and meta-analysis (2025) · cites this paper as [61]
There is no universally accepted gold standard for measuring medication adherence.
“Currently, there is no universally accepted gold standard for measuring medication adherence, as all existing methods have inherent strengths and limitations.130, 131, 132”
From Adherence to PCSK9 Inhibitors in Clinical Practice (2026) · cites this paper as [132]
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References 52 · Cited by 1,308
Research works printed but not linked: 5
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- Authors
- Lam, W. Y., & Fresco, P.
- Affiliations
- UCL School of Pharmacy (GB)
- Universidade do Porto (PT)
- Corresponding author
- Fresco, Paula
- Venue
- BioMed Research International
- Publisher
- Wiley
- Published
- 2015
- Volume
- 2015
- Pages
- 1-12
- ISSN
- 1110-7243 (ISSN-L)
- 2314-6133
- 2314-6141
- PMC
- PMC4619779
- OpenAlex
- W2145909170
- Cited by
- 1,308
- References
- 52
- Citations by year
- 2026: 92 · 2025: 145 · 2024: 149 · 2023: 141 · 2022: 166 · 2021: 167 · 2020: 142 · 2019: 128 · 2018: 95 · 2017: 63 · 2016: 20
- FWCI
- 9.81
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- BioMed Research International (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Social Sciences › Sociology and Political Science › Survey Methodology and Nonresponse
- Keywords
- medication adherence, adherence measurement, pill count, self-report, clinician assessment, chronic disease, medication non-adherence, adherence interventions
- MeSH terms
- Chronic Disease, Humans, Health Care Costs, Medication Adherence
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