Saurav Basu*, Suneela Garg, Nandini Sharma, M. Meghachandra Singh
Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
Abstract
Improving patient survival and quality of life in chronic diseases requires prolonged and often lifelong medication intake. Less than half of patients with chronic diseases globally are adherent to their prescribed medications which preclude the full benefit of treatment,
worsens therapeutic outcomes, accelerates disease progression, and causes enormous economic losses. The accurate assessment of medication adherence is pivotal for both researchers and clinicians. Medication adherence can be assessed through both direct and
indirect measures. Indirect measures include both subjective (self‑report measures such as questionnaire and interview) and objective (pill count and secondary database analysis) measures and constitute the mainstay of assessing medication adherence. However, the
lack of an inexpensive, ubiquitous, universal gold standard for assessment of medication adherence emphasizes the need to utilize a combination of measures to differentiate adherent and nonadherent patients. The global heterogeneity in health systems precludes
the development of a universal guideline for evaluating medication adherence. Methods based on the secondary database analysis are mostly ineffectual in low‑resource settings lacking electronic pharmacy and insurance databases and allowing refills without updated,
valid prescriptions from private pharmacies. This significantly restricts the choices for assessing adherence until digitization of medical data takes root in much of the developing world. Nevertheless, there is ample scope for improving self‑report measures of adherence.
Effective interview techniques, especially accounting for suboptimal patient health literacy, validation of adherence questionnaires, and avoiding conceptual fallacies in reporting adherence can improve the assessment of medication adherence and promote understanding
of its causal factors.
Keywords: Assessment, Diabetes, Hypertension, Low‑resource settings, Medication adherence
