Priti P Pednekar1, Tamás Ágh2, Maria Malmenäs3, Amit D Raval4, Bryan M Bennett5, Bijan J Borah6, David S Hutchins7, Elizabeth Manias8, Allison F Williams9, Mickaël Hiligsmann10, Adina Turcu-Stiolica11, John E Zeber12, Lusine Abrahamyan13, Thomas J Bunz14, Andrew M Peterson15. 1. Mayes College of Healthcare Business and Policy, University of the Sciences, Philadelphia, PA, USA. Electronic address: ppednekar@mail.usciences.edu. 2. Syreon Research Institute, Budapest, Hungary. 3. Real World Strategy & Analytics, Mapi Group, Stockholm, Sweden. 4. HealthCore, Inc., Wilmington, DE, USA. 5. Adelphi Values, Bollington, Cheshire, UK. 6. Division of Health Care Policy and Research, Mayo Clinic College of Medicine, Rochester, MN, USA. 7. CVS Caremark, Scottsdale, AZ, USA. 8. School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Burwood, Victoria, Australia. 9. School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia. 10. Department of Health Services Research, Maastricht University, Maastricht, The Netherlands. 11. Department of Pharmaceutical Marketing and Management, University of Medicine and Pharmacy, Craiova, Romania. 12. Central Texas Veterans Health Care System, Scott & White Healthcare, Center for Applied Health Research, Temple, TX, USA. 13. THETA, Toronto, Ontario, Canada. 14. Aetna Consumer Analytics, Granby, CT, USA. 15. Mayes College of Healthcare Business and Policy, University of the Sciences, Philadelphia, PA, USA.
Abstract
BACKGROUND: A broad literature base exists for measuring medication adherence to monotherapeutic regimens, but publications are less extensive for measuring adherence to multiple medications. OBJECTIVES: To identify and characterize the multiple medication adherence (MMA) methods used in the literature. METHODS: A literature search was conducted using PubMed, PsycINFO, the International Pharmaceutical Abstracts, the Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library databases on methods used to measure MMA published between January 1973 and May 2015. A two-step screening process was used; all abstracts were screened by pairs of researchers independently, followed by a full-text review identifying the method for calculating MMA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to conduct this systematic review. For studies that met the eligibility criteria, general study and adherence-specific characteristics and the number and type of MMA measurement methods were summarized. RESULTS: The 147 studies that were included originated from 32 countries, in 13 disease states. Of these studies, 26 used proportion of days covered, 23 used medication possession ratio, and 72 used self-reported questionnaires (e.g., the Morisky Scale) to assess MMA. About 50% of the studies included more than one method for measuring MMA, and different variations of medication possession ratio and proportion of days covered were used for measuring MMA. CONCLUSIONS: There appears to be no standardized method to measure MMA. With an increasing prevalence of polypharmacy, more efforts should be directed toward constructing robust measures suitable to evaluate adherence to complex regimens. Future research to understand the validity and reliability of MMA measures and their effects on objective clinical outcomes is also needed.
BACKGROUND: A broad literature base exists for measuring medication adherence to monotherapeutic regimens, but publications are less extensive for measuring adherence to multiple medications. OBJECTIVES: To identify and characterize the multiple medication adherence (MMA) methods used in the literature. METHODS: A literature search was conducted using PubMed, PsycINFO, the International Pharmaceutical Abstracts, the Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library databases on methods used to measure MMA published between January 1973 and May 2015. A two-step screening process was used; all abstracts were screened by pairs of researchers independently, followed by a full-text review identifying the method for calculating MMA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to conduct this systematic review. For studies that met the eligibility criteria, general study and adherence-specific characteristics and the number and type of MMA measurement methods were summarized. RESULTS: The 147 studies that were included originated from 32 countries, in 13 disease states. Of these studies, 26 used proportion of days covered, 23 used medication possession ratio, and 72 used self-reported questionnaires (e.g., the Morisky Scale) to assess MMA. About 50% of the studies included more than one method for measuring MMA, and different variations of medication possession ratio and proportion of days covered were used for measuring MMA. CONCLUSIONS: There appears to be no standardized method to measure MMA. With an increasing prevalence of polypharmacy, more efforts should be directed toward constructing robust measures suitable to evaluate adherence to complex regimens. Future research to understand the validity and reliability of MMA measures and their effects on objective clinical outcomes is also needed.
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