TY - JOUR
T1 - Methods for Measuring Multiple Medication Adherence
T2 - A Systematic Review-Report of the ISPOR Medication Adherence and Persistence Special Interest Group
AU - Pednekar, Priti P.
AU - Agh, Tamas
AU - Malmenas, Maria
AU - Raval, Amit D.
AU - Bennett, Bryan M.
AU - Borah, Bijan J.
AU - Hutchins, David S.
AU - Manias, Elizabeth
AU - Williams, Allison F.
AU - Hiligsmann, Mickael
AU - Turcu-Stiolica, Adina
AU - Zeber, John E.
AU - Abrahamyan, Lusine
AU - Bunz, Thomas J.
AU - Peterson, Andrew M.
N1 - Funding Information:
We extend special thanks to Theresa Tesoro at ISPOR–the professional society for health economics and outcomes research, and the librarian of the University of the Sciences for their support. Source of financial support: The authors have no other financial relationships to disclose.
Publisher Copyright:
© 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research
PY - 2019/2
Y1 - 2019/2
N2 - 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.
AB - 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.
KW - measurement method
KW - medication adherence
KW - medication possession ratio
KW - persistence
KW - polypharmacy
KW - proportion of days covered
KW - self-reported measures
KW - QUALITY-OF-LIFE
KW - COMBINATION ANTIRETROVIRAL THERAPY
KW - TYPE-2 DIABETES-MELLITUS
KW - BLOOD-PRESSURE CONTROL
KW - HIV-INFECTED PATIENTS
KW - SELF-REPORT
KW - PATIENT ADHERENCE
KW - DRUG-USERS
KW - HOSPITALIZATION RISK
KW - PREDICTIVE-VALIDITY
U2 - 10.1016/j.jval.2018.08.006
DO - 10.1016/j.jval.2018.08.006
M3 - (Systematic) Review article
SN - 1098-3015
VL - 22
SP - 139
EP - 156
JO - Value in Health
JF - Value in Health
IS - 2
ER -