TY - JOUR

T1 - Methodological considerations on estimating medication adherence from self-report, electronic monitoring, and electronic healthcare databases using the TEOS framework

AU - Dima, Alexandra L.

AU - Allemann, Samuel S.

AU - Dunbar-Jacob, Jacqueline

AU - Hughes, Dyfrig

AU - Vrijens, Bernard

AU - Wilson, Ira

N1 - Agence Nationale de la Recherche. Grant Number: ANR-16-IDEX-0005 Health and Care Research Wales. Grant Number: SRL-19-18 Instituto de Salud Carlos III. Grant Number: CP21/00062 National Institute for Health Research. Grant Number: Trials Methodology Research Partnership MR/S014357 National Institute of General Medical Sciences. Grant Number: Advance-CTR Providence/Boston Center for AIDS Research. Grant Number: P30AI042853 Rhode Island Institutional Development Award. Grant Number: U54GM115677

PY - 2023/7

Y1 - 2023/7

N2 - AimsMeasuring adherence to medication is complex due to the diversity of contexts in which medications are prescribed, dispensed and used. The Timelines-Events-Objectives-Sources (TEOS) framework outlined a process to operationalize adherence. We aimed to develop practical recommendations for quantification of medication adherence using self-report (SR), electronic monitoring (EM) and electronic healthcare databases (EHD) consistent with the TEOS framework for adherence operationalization.MethodsAn adherence methodology working group of the International Society for Medication Adherence (ESPACOMP) analysed implications of the process of medication adherence for all data sources and discussed considerations specific to SR, EM and EHD regarding the information available on the prescribing, dispensing, recommended and actual use timelines, the four events relevant for distinguishing the adherence phases, the study objectives commonly addressed with each type of data, and the potential sources of measurement error and quality criteria applicable.ResultsFour key implications for medication adherence measurement are common to all data sources: adherence is a comparison between two series of events (recommended and actual use); it refers to one or more specific medication(s); it applies to regular repeated events coinciding with known recommended dosing; and it requires separate measurement of the three adherence phases for a complete picture of patients' adherence. We propose recommendations deriving from these statements, and aspects to be considered in study design when measuring adherence with SR, EM and EHD using the TEOS framework.ConclusionThe quality of medication adherence estimates is the result of several design choices that may optimize the data available.

AB - AimsMeasuring adherence to medication is complex due to the diversity of contexts in which medications are prescribed, dispensed and used. The Timelines-Events-Objectives-Sources (TEOS) framework outlined a process to operationalize adherence. We aimed to develop practical recommendations for quantification of medication adherence using self-report (SR), electronic monitoring (EM) and electronic healthcare databases (EHD) consistent with the TEOS framework for adherence operationalization.MethodsAn adherence methodology working group of the International Society for Medication Adherence (ESPACOMP) analysed implications of the process of medication adherence for all data sources and discussed considerations specific to SR, EM and EHD regarding the information available on the prescribing, dispensing, recommended and actual use timelines, the four events relevant for distinguishing the adherence phases, the study objectives commonly addressed with each type of data, and the potential sources of measurement error and quality criteria applicable.ResultsFour key implications for medication adherence measurement are common to all data sources: adherence is a comparison between two series of events (recommended and actual use); it refers to one or more specific medication(s); it applies to regular repeated events coinciding with known recommended dosing; and it requires separate measurement of the three adherence phases for a complete picture of patients' adherence. We propose recommendations deriving from these statements, and aspects to be considered in study design when measuring adherence with SR, EM and EHD using the TEOS framework.ConclusionThe quality of medication adherence estimates is the result of several design choices that may optimize the data available.

KW - adherence

KW - methodology

KW - pharmacotherapy

U2 - 10.1111/bcp.15375

DO - 10.1111/bcp.15375

M3 - Article

VL - 89

SP - 1918

EP - 1927

JO - British Journal of Clinical Pharmacology

JF - British Journal of Clinical Pharmacology

SN - 0306-5251

IS - 7

ER -