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.
To understand the different constructs of adherence behaviour and techniques to assess them.
To describe strengths and limitations of different techniques with respect to validity and implementation.
To select the assessment technique(s) most appropriate for the research objective.
To understand issues linked to the use of (non-)adherence and biomedical outcomes and (non-) adherence itself as an outcome for intervention studies.
Principles of adherence (Robert Gross). 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.
Subjective measurements (Jacqueline Hugtenburg). 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.
Objective measurements: prescription and refill databases (Julie Lauffenburger). 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.
Objective measurements: electronic devices (Job van Boven). Students will be introduced to the use of electronic devices and new developments for measuring adherence.
Case presentation (Robert Gross, Julie Lauffenburger, Job van Boven, Jacqueline Hugtenburg). A case for the live plenary session will be introduced, which will connect the four prior presentations.