Methodological Challenges Associated with the Measurement of Medication Adherence in Patients with Cardiovascular Disease

Abstract

Medication adherence is at the cornerstone of effective treatment and management of cardiovascular disease (CVD). Despite the availability of numerous efficacious medications to manage CVD, adherence to prescribed medications remains suboptimal. While much work has been done to understand the barriers to medication adherence in patients with CVD, an equally problematic area is the impact that the measure selected to assess medication adherence has on the intended outcomes. One of the primary challenges to the field is the notion that no single measure can be considered the “gold standard” for all types of research or clinic settings. In this chapter, we review the evidence to date that addresses the methods to assess medication adherence in patients with CVD. Specifically, the objectives of this chapter are (1) to review the importance of selecting accurate measures to assess medication adherence and common challenges of adherence measurement, (2) to discuss the strengths and weaknesses of medication adherence measures currently utilized in the CVD literature and discuss their relation to CVD-related outcomes, (3) to evaluate the level of agreement among the various adherence measures, and (4) to highlight special considerations when selecting self-report adherence measures in particular subgroups. Finally, we conclude with a discussion of current innovations in methods to assess medication adherence and offer future implications for research and clinical applications.KeywordsMedical adherenceNon-adherenceElectronic monitoring devicesPill count