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THE PHARMA REVIEW (SEPTEMBER - OCTOBER 2011)

A Systematic Review on the Tools and Indicators of Medication Adherence

Uday Venkat M1, Rajesh V1, Srikala P2, Anantha Naik Nagappa3

Abstract
Medication adherence is a leading issue and a huge burden in our current healthcare system. In fact a growing needs for more research in this area, to help in designing disease-management programs that specifically aim at the educational interventions of the elderly patients who are most likely to be noncompliant. There by improved adherence should, in turn, lead to improved health outcomes. In this article, we rendered a simplistic overview of methodologically proven tools and indicators of medication adherence enhancing strategies so that the research can be translated and applied to patient care settings.
Introduction
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. These recommendations often include taking medications as well as making lifestyle changes such as cessation of smoking, eating right and getting the right kind of physical activity in daily life. Unfortunately, many patients do not recognize the importance of following their doctor’s advice in maintaining their health. These components such as knowledge of medication, timely filling of prescriptions, exact dosage, accurate timing of the doses, approximate sequence of taking the drug, correct length of therapy, and timely attendance for follow-up appointments. Poor adherence to prescribed regimens can result in serious health consequences. For instance, a recent study found that the risk of hospitalization was more than double in patients with diabetes mellitus, hypercholesterolemia, hypertension, or congestive heart failure that were nonadherent to prescribed therapies compared with the general population2,3.
Different Tools to Measure the Medication Adherence
The tools available for measuring adherence can be divided into direct and indirect tools of measurement (Figure 1) 4,5. Each tool has advantages and disadvantages, and no tool is considered the gold standard.
Directly observed therapy, measurement of concentrations of a drug or its metabolite in blood or urine, and detection or measurement in blood of a biologic marker added to the drug formulation are examples of direct methods of measures of adherence. For instance, the serum concentration of narrow therapeutics drugs such as digoxin, theophylline, phenytoin and valproic acid etc, will probably reflect adherence to regimens with these medications, and subtherapeutic levels will probably reflect poor adherence or suboptimal dose strengths.

 

 

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