Medication Adherence – Explaining Some of the Terms
This page provides descriptions or explanations for various adherence-related words or phrases that are used within posts to this site. The list is in alphabetical order. I hope you find it useful.
The plan is to update this list periodically. If you have suggestions for improving an explanation, or for additional words or phrases that should be included, please let me know at firstname.lastname@example.org.
Please note that throughout the following text the abbreviation HCP is used for ‘healthcare provider’. An explanation of the term ‘healthcare provider’ is included in the list below.
Term + Explanation or Description
Adherence describes the act of taking medications exactly as prescribed by a doctor. This involves sticking to the prescribed medication regimens (right tablets, right frequency of dosing, right number of tablets at each dosing occasion, etc).
Adherence as mediator
Medication adherence is a mediator in the sense that it can help achieve desired healthcare outcomes. For example, a healthcare provider (HCP) and a patient may discuss and agree the use of a particular medication. In this discussion, they may review the desired outcome of the medication’s use, perhaps in terms of improving the patient’s health status. However, achievement of this goal depends on the patient taking the medication as instructed by the HCP (ie, medication adherence). In the example given, adherence may be a key factor in achieving the target improvement in the patient’s health status.
This term describes the various ways in which a patient’s adherence to a prescribed medication’s regimen can be measured. There are many different measures that can be used, but unfortunately all have drawbacks. The most common measure is called ‘proportion of days covered’ (PDC). This uses prescription fill data to calculate the percentage of days a patient has medication on hand to take for their chronic conditions.
Hard data on a patient’s adherence may be difficult to get. Without this data, physicians may estimate adherence based on – for example – office conversations held with a patient. This term reflects the observation that physicians tend to overestimate how well patients are adhering to their medications’ regimens. A tendency to overestimate patients’ adherence levels may adversely affect doctors’ views on the importance of dealing with non-adherence.
This term is used to describe the degree to which HCPs, patients, or other stakeholders believe they are responsible for improving adherence. As an example, physicians currently have a low sense of responsibility for adherence (hopefully this will improve).
When used in this site, behavior change specifically relates to improving adherence. For example, to improve adherence healthcare groups and individuals within these groups will need to change the way they work. And patients will need to change the way they take their medications.
This describes multidisciplinary groups of healthcare professionals thinking collectively about adherence solutions. An example could be physicians, pharmacists, and payers working together to agree how best to create practical, multi-component solutions.
Communications between patients and healthcare providers (HCPs) may at times be difficult, as healthcare terminology is often complex and not easy to follow. So quality of communications is very important. For the HCP, quality might mean using everyday terms the patient can understand. It may also mean using a collaborative approach, with two-way discussion of treatment options, risks, and benefits. For the patient, it may mean asking questions to ensure full understanding. The quality of communications between a HCP and patient are critical to ensure
A common reason for nonadherence is medicines being too expensive for patients to afford. Many payers have introduced programs of reducing (or even eliminating) medication costs for certain patients to help improve adherence. This is what is meant by cost mitigation. The rationale for this approach is based on the preventing serious longer-term consequences (eg, morbidities, hospitalizations) and also preventing the costs associated with these consequences.
Diagnosis of non-adherence reasons
To improve adherence, HCPs need to get better at identifying and understanding an individual patient’s reasons for non-adherence. This is an activity that should be carried out regularly with patients on long-term therapies.
This refers to the use of emergency departments’ services, when patients need urgent medical care. Studies have suggested that lack of adherence to medications leads to more ED use.
For site posts, this term applies to government agencies that underwrite healthcare costs or influence policy. Examples are Medicare, Medicaid, and the Agency for Healthcare Research and Quality (AHRQ). Several government agencies have introduced programs that promote medication adherence.
Incentives to encourage HCPs to more actively engage in improving adherence. Such incentives might include HCP reimbursement for adherence-related activities like patient education, patient motivation, and patient behavior changes.
The resources that HCPs need to be better prepared to improve patient adherence. Examples are education, training, and tools.
In posts, this specifically relates to limitations on the time HCPs spend with patients. For example, HCP administrative tasks may limit this time, which can adversely affect their ability to deal with adherence issues. Healthcare system changes may be required so HCPs can devote more time to improving adherence.
Healthcare provider (HCP)
This term describes any individual or organization that provides health services to individuals that need them. Healthcare providers include physicians, pharmacists, nurses, physician assistants, dentists, and many other licensed healthcare practitioners.
Healthcare provider groups
Provider groups are healthcare organizations that control diverse provider types and services, often across diverse locations. Examples are ACOs or PCMHs. Such organizations focus on improving care coordination between different healthcare groups. For instance, ensuring continuity of care between hospital and community physicians when a patient is discharged from hospital. Providing continuity of medication adherence may be a component of coordinated care.
The overall money spent on healthcare services by government, employers, patients, and the public (eg, through healthcare insurance). For 2011 this figure was $2.7 trillion. Non-adherence to medications is estimated to contribute about $300 billion to this number.
This refers to individuals who are admitted – or readmitted – into hospital as an inpatient. Studies have suggested that lack of adherence to medications leads to more hospital admissions.
Insights about medication adherence come from interpretation of relevant information and data. Insights are important because they build understanding. Improved understanding helps identify directions that can lead to better solutions for improving adherence.
Actions initiated to improve medication adherence. For example, such activities may be designed to mitigate cost, provide social support, gain better understanding of adherence, achieve better communication, simplify medications, change patient behaviors, and address patient motivation or beliefs.
In the context of site posts, this specifically relates to leadership of initiatives to improve adherence. For example, this may apply to leadership of programs to drive adoption of new HCP behaviors, or to set examples that will influence other HCPs.
This refers to the lessons learned from experience – both positive and negative – that can guide and direct future efforts to improve adherence.
A medicine or drug prescribed by a doctor or other licensed HCP to treat a particular medical condition.
When a medication regimen is more complex (eg, multiple tablets, multiple times a day), the greater the likelihood of nonadherence. Medication simplification describes the process where healthcare providers (HCPs) seek to reduce the potential fo nonadherence by simplifying dosage and dosing frequency (eg, single tablet, once daily – whenever possible).
Patients typically have several reasons for Non-adherence. To effectively improve adherence often requires a combination of several intervention types. With interventions selected to directly address an individual’s non-adherence reasons. In site posts, such combinations of interventions are described as multi-component solutions.
This means not taking a medication exactly as instructed by a doctor or pharmacist (eg, missing doses, taking too many or too few tablets).
Non-adherence can differ from patient to patient. For example, one patient may miss tablets early on, but becomes more more adherent as time goes by. Another patient may start off taking a medication as instructed, but over time becomes increasingly non-adherent. A third patient may be consistently erratic in their tablet taking, without any clear pattern. These are examples of different non-adherence behaviors. Understanding these different behaviors – and the reasons underlying these behaviors – can provide important insights into how best to manage and improve patients’ adherence to medications.
HCPs need to look for and identify non-adherence to medications. This is what nonadherence detection refers to. For example, physicians may question a patient about his/her adherence during office visits. Alternatively payers or pharmacists can identify non-adherence because a patient does not pick up a refill.
These are the barriers, causes, factors, or reasons that influence a patient not to adhere to medication regimens. Identifying and understanding these reasons provides a strong base from which to develop effective adherence solutions.
Outcomes refer to the impact of healthcare actions on patients. For example, it may describe the change in health status resulting from a therapeutic or medical intervention. In site posts, outcomes will often refer to the impacts of medication adherence or non-adherence on a patient’s health status.
This term refers to an individual’s ability to engage in self-management of their health and their healthcare (eg, medication-taking). The degree to which patients are prepared and able to manage their medication-taking outside of a doctor’s office impacts the success of treatment. For example, a poorly-activated patient is less likely to take a medication as instructed. Because of this, the patient is less likely to get benefit from the treatment.
Often patient misunderstandings about diseases and their consequences, or about medications and their effects/side effects, can be causes of nonadherence. Patient education describes how healthcare providers (HCPs) work with patients to address such areas of possible confusion. Typically this will involve two-discussion and counseling to reduce misunderstandings and establish more a positive benefits-to-concerns ratio. Patient education is typically a important component of interventions to improve medication adherence.
This describes the patient-physician process for agreeding actions that must be taken to get greatest benefit from a treatment. In the case of medication adherence, this will center on information and motivational support that reinforces patient commitment to take a medication exactly as recommended. Collaborative or shared decision-making between a patient and his/her doctor is an example of patient engagement.
This describes the process where healthcare providers (HCPs) follow-up with patients between office visits. This could be by phone, text, or face-to-face. In the context of medication adherence reasons for follow-up may include: ensuring understanding of the patient’s condition and the consequences of poor disease control, answering any new questions, checking medication adherence, or re-emphasizing the importance of sticking to the prescribed regimen.
A patient reason-set describes the specific reasons why a patient is non-adherent. Individual reason-sets are relatively unique and may differ widely from one patient to the next. Understanding a patient’s specific reason-set is a great starting point for improving adherence.
Trust is an important component of patient-physician relationships. For patients to believe they are making the right decision, they must be confident that physicians have given them the correct information. Without this belief, patients may not have the confidence to fully follow-through on the agreed course of action. Trust in a physician is a key determinant of whether a patient will adhere to his/her medication regimen.
Payers are organizations that finance or reimburse the cost of health services. Examples are health insurance carriers or health plan sponsors (eg, employers or unions).
Pharmacists prepare and dispense medications that a doctor prescribes. Pharmacists also provide great medication-related advice to patients. This includes adherence-related advice and guidance.
Physician time investment
This refers to physicians allocating enough time with each patient to address their individual needs or concerns. Doctors have many demands on their time, including a rising number of administrative tasks. Allocating the time needed to build patient relationships, engagement, and trust – and have quality conversations – can be challenging.
Doctors, MDs, family practitioners, specialists, primary care physicians, etc. Patients with chronic medical conditions visit their physicians on a regular basis. Physicians are therefore well placed to regularly check that patients are adhering to their medications.
Regimen describes the instructions or plan for how a particular medication must be taken (eg, the dosing frequency, the number of tablets to be taken at each dosing occasion).
This description arises from the observation that information on adherence is widely scattered across the Web. Also it is often presented as individual, disconnected ‘nuggets’. This fragmentation adds to the difficulty answering key adherence-related questions.
Shared desicion-making is when physicians and patients communicate together to make informed healthcare decisions (eg, treatment choices). Physicians have knowledge of the treatment options, as well as their benefits and risks. Patients can then match these options to their personal preferences and beliefs; to make the best, personalized care decision.
This term is used to describe tailoring adherence solutions to an individual patient’s needs. A patient’s specific non-adherence reasons should be identified and interventions then carefully selected to address each of the reasons.
Value-based insurance design (VBID)
VBID promotes the use of healthcare services where the benefits (eg, outcomes) outweigh the costs. For example, payers may reduce – or even eliminate – the cost of an oral medication for diabetes, in order to improve adherence. They do this because a diabetic patient who adheres to the medication may be less likely to be admitted to hospital or less likely to experience a serious medical event. For payers, future healthcare cost savings for the adherent patient will likely offset near-term income losses.
Value of care
This term relates to the ‘value’ of healthcare interventions (eg, medications). The two components of value in this context are quality of care and cost-effectiveness of care. An example of quality is acheivement of a desired outcome for a patient’s health status. While an example of cost-effectiveness might relate to efficient usage of healthcare resources. Medication adherence can be a key mediator in both these processes.
Volume of care
Volume of care is a term relevant to a fee-for-service healthcare system. It describes the number of service events (tests, imaging, medications, referrals, etc.) that health care providers order for patients. This ‘volume’ approach is losing favor, with greater emphasis now being placed on ‘value of care’.
WHO 2003 report
“Adherence to Long-term Therapies: Evidence for Action”; this critical, evidence-based review published by the World Health Organization (WHO) in 2003 remains one of the most relevant, most complete documents on the issue of medication adherence.