What We Mean When We Talk About Adherence in Respiratory Medicine

Bernard Vrijens; Alexandra L Dima; Eric Van Ganse; Job F M van Boven; Michelle N Eakin; Juliet M Foster; Marijn de Bruin; Alison Chisholm; David Price

doi:10.1016/j.jaip.2016.05.019

What We Mean When We Talk About Adherence in Respiratory Medicine

J Allergy Clin Immunol Pract. 2016 Sep-Oct;4(5):802-12. doi: 10.1016/j.jaip.2016.05.019.

Authors

Bernard Vrijens¹, Alexandra L Dima², Eric Van Ganse³, Job F M van Boven⁴, Michelle N Eakin⁵, Juliet M Foster⁶, Marijn de Bruin⁷, Alison Chisholm⁸, David Price⁹

Affiliations

¹ WestRock Healthcare, Visé, Belgium; Department of Public Health, University of Liège, Liège, Belgium. Electronic address: bernard.vrijens@westrock.com.
² Amsterdam School of Communication Research ASCoR, University of Amsterdam, Amsterdam, The Netherlands.
³ Pharmaco-Epidemiology Lyon (PEL), HESPER, Claude Bernard University, Lyon, France; Respiratory Medicine, Croix-Rousse University Hospital, Lyon, France.
⁴ Department of Primary Care, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁵ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Md.
⁶ Woolcock Institute of Medical Research, Clinical Management Group, University of Sydney, Sydney, Australia.
⁷ Amsterdam School of Communication Research ASCoR, University of Amsterdam, Amsterdam, The Netherlands; Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
⁸ Respiratory Effectiveness Group, Cambridge, UK.
⁹ Respiratory Effectiveness Group, Cambridge, UK; Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.

PMID: 27587314
DOI: 10.1016/j.jaip.2016.05.019

Abstract

Adequate medication adherence is key for optimal benefit of pharmacological treatments. A wealth of research has been conducted to understand and identify opportunities to intervene to improve medication adherence, but variations in adherence definitions within prior research have led to ambiguity in study findings. The lack of a standard taxonomy hinders the development of cumulative science in adherence research. This article reviews the newly established Ascertaining Barriers to Compliance (ABC) taxonomy for medication adherence with a particular focus on its relevance and applicability within the context of asthma and chronic obstructive pulmonary disease management. Building on traditional definitions and concepts within medication adherence, the ABC taxonomy considers the temporal sequence of steps a patient must undertake to be defined as "adherent to treatment": (A) initiation, (B) implementation, and (C) persistence. We explain the clinical and research relevance of differentiating between these phases, point to differences in its applicability in observational and experimental research, review strengths and limitations of available measures, and highlight recent findings on specific determinants of these behaviors. Finally, we provide recommendations for research and practice with a view to supporting and sign posting opportunities to improve future respiratory medication adherence and associated research.

Keywords: ABC taxonomy; Asthma; Chronic obstructive pulmonary disease (COPD); Implementation; Initiation; Medication adherence; Persistence.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Asthma / drug therapy*
Humans
Medication Adherence*
Pulmonary Disease, Chronic Obstructive / drug therapy*
Pulmonary Medicine / classification