Adherence: Comparison of Methods to Assess Medication Adherence and Classify Nonadherence
Abstract
Background: Medication adherence is suboptimal, and clinicians and researchers struggle with identifying nonadherent patients. Various measures of medication adherence exist, but there is controversy regarding which measures provide acceptable data and how nonadherence should be defined. Objective: To assess agreement among patient self-report, pharmacy refill, and electronic adherence measures and compare the sensitivity and specificity of different cut-points for defining nonadherence. Methods: Data were analyzed from 2 similarly designed randomized controlled trials that assessed a pharmacist's intervention to improve medication adherence among patients with hypertension or heart failure. For each participant, adherence was measured by patient self-report, prescription refill records, and electronic lids on medication containers. Agreement among measures was assessed using Spearman's correlation coefficient rho. Correlation coefficients were compared by patient characteristics using Fisher's Z transformation, The sensitivity and specificity of different cut-points for defining nonadherence were calculated. Results: Median adherence was 84% for self-report, 86% for electronic, and 91% for prescription refill adherence measurement. Refill and electronic adherence demonstrated the best agreement among measures (rho = 0.48). Age, depression, and other comorbid conditions influenced agreement among measures. Measures were generally in agreement, regardless of how nonadherence was defined. A cut-point of 80% illustrated a fair balance between sensitivity and specificity for all measures. Conclusions: All measures provided similar estimates of overall adherence, although refill and electronic measures were in highest agreement. In selection of a measure, practitioners should consider population and disease characteristics, since measurement agreement could be influenced by these and other factors. The commonly used, clinically based cut-point of 80% had a reasonable balance between sensitivity and specificity in studies of adherence in patients with heart failure or hypertension.
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Medication non-adherence is a widespread problem that causes high costs worldwide.
“Medication non-adherence is a widespread problem that causes high costs worldwide [5–10].”
From Medication adherence influencing factors—an (updated) overview of systematic reviews (2019) · cites this paper as [9]
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- Authors
- Hansen, R. A., Kim, M. M., Song, L., Tu, W., Wu, J., & Murray, M. D.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Shaw University (US)
- Regenstrief Institute (US)
- Indiana University School of Medicine (US)
- Venue
- Annals of Pharmacotherapy
- Publisher
- SAGE Publications
- Published
- 2009-03
- Volume
- 43
- Issue
- 3
- Pages
- 413-422
- ISSN
- 0012-6578 (ISSN-L)
- 1060-0280
- 1542-6270
- OpenAlex
- W2124742359
- Cited by
- 274
- References
- 30
- Citations by year
- 2026: 1 · 2025: 9 · 2024: 16 · 2023: 7 · 2022: 14 · 2021: 17 · 2020: 17 · 2019: 24 · 2018: 23 · 2017: 15 · 2016: 18 · 2015: 16 · 2014: 16 · 2013: 19 · 2012: 23
- FWCI
- 15.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Pharmacotherapy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (R01 AG 19105, R01AG019105)
- National Heart, Lung, and Blood Institute (R01HL69399, R01HL069399)
- National Center for Research Resources (K12RR023248)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- medication adherence, patient self-report, sensitivity and specificity, hypertension, heart failure, pharmacist intervention, depression, comorbidities
- MeSH terms
- Assessment of Medication Adherence, Data Collection, Female, Humans, Male, Middle Aged, Patient Education as Topic, Pharmaceutical Services, Drug Prescriptions, Sensitivity and Specificity, Drug Monitoring, Medication Adherence
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