Is There a Threshold for Medication Adherence? Lessons Learnt From Electronic Monitoring of Drug Adherence.

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Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_345ABEACC3CD
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Is There a Threshold for Medication Adherence? Lessons Learnt From Electronic Monitoring of Drug Adherence.
Journal
Frontiers in pharmacology
Author(s)
Burnier M.
ISSN
1663-9812 (Print)
ISSN-L
1663-9812
Publication state
Published
Issued date
2018
Peer-reviewed
Oui
Volume
9
Pages
1540
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Medication adherence is a well-recognized problem in the management of patients with chronic diseases needing a long-term pharmacotherapy. While fighting against non-adherence, an important question frequently arises, i.e., how much adherence is enough to obtain the full treatment benefits? Most studies having attempted to answer this question have used large pharmacy records and health care databases to quantify the percentage of days covered by the prescribed treatment and hence deduce a threshold below which there appears to be fewer benefits from therapy. In the present paper, the use of data obtained using electronic monitoring of adherence is discussed as another means to assess adherence thresholds with a particular emphasis on hypertension. The data show that even with the use of electronic monitoring of adherence, which provides a comprehensive dosing history, it is extremely difficult to define an adherence threshold in hypertension. This is due to many factors that need to be taken into account, including not only the pattern of patients' adherence and their clinical and environmental characteristics, but also the pharmacological characteristics of the prescribed drugs, the severity of the disease and many others. To determine adherence cut-offs more precisely, specific protocols should be designed to answer the question in various clinical conditions. These protocols should be conducted in well-defined patients' groups, they should use the most reliable methods to measure adherence providing if possible a detailed dosing history perhaps combined with drugs levels in blood or urine. These studies should also choose the best methods to measure clinical endpoints, such as ambulatory blood pressure monitoring or home blood pressure in the case of hypertension. One important aspect is that datasets should be solid and large enough to be able to analyze adherence data as a continuous variable using newly developed mathematical models including new metrics catching the complexity of adherence. The rapid development of new technologies like devices, connectivity, and analytics, will probably provide new solutions to improve our ability to define valid and clinically useful adherence thresholds in various therapeutic areas.
Keywords
blood pressure, cardiovascular, genotype, hypertension, percentage days covered, pharmacology
Pubmed
Web of science
Open Access
Yes
Create date
27/02/2019 12:08
Last modification date
20/08/2019 13:21
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