Adherence to Medication

‎1. Course Aim ‎

Adherence to medication is indispensable for achieving clinical goals. Non-adherence is a complex and ‎multifactorial problem leading to poor clinical outcomes, increased morbidity and death rates, and unnecessary ‎healthcare costs. Assessing (non-)adherence is challenging and both subjective and objective measures are ‎applied. This course is aimed at introducing students to the various constructs of adherence behaviour and ‎techniques to evaluate (non-)adherence and data analysis. Using several examples of studies among patients ‎using a variety of medicines, students are guided through the subsequent steps in making decisions concerning ‎measurements and analyses of data. The influence of a variety of assumptions and decisions is shown, and ‎students are guided through the process of data preparation and transformation needed for adherence ‎calculations. ‎

‎2. Requisites Statement ‎

Entry level.‎

‎3. Course Objectives‎

‎1.‎ To understand the different constructs of adherence behavior and techniques to assess them.‎
‎2.‎ To describe strengths and limitations of different techniques with respect to validity and ‎implementation. ‎
‎3.‎ To select the assessment technique(s) most appropriate for the research objective.‎
‎4.‎ To understand issues linked to the use of (non-)adherence and biomedical outcomes and (non-) ‎adherence itself as an outcome for intervention studies.‎

‎4. Syllabus Outline‎

‎1. Principles of adherence.‎
Students will be introduced to the definitions and taxonomy of adherence to medication, as well as to the ‎various types and factors/causes of non-adherence as well as consequences. Subjective and objective measures ‎used to quantify (non-)adherence, and challenges in the analysis of outcomes will be presented. How adherence ‎research relates to pharmacoepidemiology will also be addressed.‎

‎2. Subjective measurements.‎
Students will be introduced to the use of self-report techniques, such as structured interviews and ‎questionnaires, used in adherence research. A variety of common questionnaires and what they assess will be ‎discussed. An example of analysis of data using techniques from pharmacoepidemiology is presented. ‎

‎3. Objective measurements: prescription and refill databases.‎
Students will be introduced to the use of objective measurements with prescription and refill databases. ‎Considerations for analysing data across constructs of adherence (initiation, implementation, persistence) will ‎be presented. Calculations and decisions for medication adherence measures (new users, prevalent users, ‎which medications, follow up, metrics) as well as trajectory techniques to summarize adherence will be ‎presented.‎

‎4. Objective measurements: electronic devices.‎
Students will be introduced to the use of electronic devices and new developments for measuring ‎adherence. ‎

‎5. Case presentation.‎
A case for the live plenary session will be introduced, which will connect the four prior presentations. ‎