Abstract
Medication adherence is a priority for health systems worldwide and is widely recognised as a key component of quality of care for disease management. Adherence-related indicators were rarely explicitly included in national health policy agendas. One barrier is the lack of standardised adherence terminology and of routine measures of adherence in clinical practice. This paper discusses the possibility of developing adherence-related performance indicators highlighting the value of measuring persistence as a robust indicator of quality of care. To standardise adherence and persistence-related terminology allowing for benchmarking of adherence strategies, the European Ascertaining Barriers for Compliance (ABC) project proposed a Taxonomy of Adherence in 2012 consisting of three components: initiation, implementation, discontinuation. Persistence, which immediately precedes discontinuation, is a key element of taxonomy, which could capture adherence chronology allowing the examination of patterns of medication-taking behaviour. Advances in eHealth and Information Communication Technology (ICT) could play a major role in providing necessary structures to develop persistence indicators. We propose measuring persistence as an informative and pragmatic measure of medication-taking behaviour. Our view is to develop quality and performance indicators of persistence, which requires investing in ICT solutions enabling healthcare providers to review complete information on patients’ medication-taking patterns, as well as clinical and health outcomes.
Highlights
It is widely recognized that medication adherence is a key component of quality of care for disease management
A US study on type 2 diabetes (T2D) assessed adherence through both proportion of days covered (PDC) and persistence, allowing a 45-day gap between two prescriptions, and highlighted that the pharmacy claims used indicated only that a prescription was filled and it remained unknown whether patients used the medication as prescribed [32]
If measures of medication persistence are to be used as performance indicators to monitor, benchmark and evaluate the quality of disease management, there are a number of challenges which need to be addressed
Summary
It is widely recognized that medication adherence is a key component of quality of care for disease management. A recent report of the OECD [8] investigating health systems efficiency stated that ‘routine medication adherence measures as well as adherence-related quality and performance indicators should be encouraged in order to improve health system effectiveness and efficiency’. Performance indicators are measures that capture a variety of health- and health systemrelated trends and factors based on an operational definition of quality [9]. According to the OECD report, very few countries routinely measure and report adherence as a quality improvement indicator or performance measures at the system level. [8] The United States and Sweden are the only OECD countries that measure and report on adherence and persistence on a routine basis at the health system level and only for cardiovascular disease [8]. The value of measuring persistence with treatment as a robust and sound indicator of quality of care within healthcare systems is highlighted
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