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Patient Prefer Adherence. 2018 Oct 5;12:1975-1987. doi: 10.2147/PPA.S164819. eCollection 2018.

Adherence to chronic medication in older populations: application of a common protocol among three European cohorts.

Author information

CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy,
Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIII, Madrid, Spain.
Aragon Health Service (SALUD), Aragon, Spain.
Department of Public Health, Federico II University, Naples, Italy.
University of Zaragoza, Zaragoza, Spain.
UCIBIO, REQUINTE, Faculty of Pharmacy, Porto4ageing Reference Site, University of Porto, Porto, Portugal.
Department of Family Medicine, Medical University of Lodz, Lodz, Poland.



The purpose of this study was to evaluate and compare medication adherence to chronic therapies in older populations across different regions in Europe.


This explorative study applied a harmonized method of data extraction and analysis from pharmacy claims databases of three European countries to compare medication adherence at a cross-country level. Data were obtained for the period between January 1, 2010, and December 31, 2011. Patients (aged ≥65 years) who newly initiated to oral antidiabetics, antihyperlipidemics, or antiosteoporotics were identified and followed for over a 12-month period. Main outcome measures were medication adherence (medication possession ratio, [MPR]; implementation) and persistence on index treatment. All country-specific data sets were prepared by employing a common data input model. Outcome measures were calculated for each country and pooled using random effect models.


In total, 39,186 new users were analyzed. In pooled data from the three countries, suboptimal implementation (MPR <80%) was 52.45% (95% CI: 33.43-70.79) for antihy-perlipidemics, 61.35% (95% CI: 52.83-69.22) for antiosteoporotics, and 30.33% (95% CI: 25.53-35.60) for oral antidiabetics. Similarly, rates of non-persistence (discontinuation) were 55.63% (95% CI: 35.24-74.29) for antihyperlipidemics, 60.24% (95% CI: 45.35-73.46) for antiosteoporotics, and 46.80% (95% CI: 36.40-57.4) for oral antidiabetics.


Medication adherence was suboptimal with >50% of older people non-adherent to antihyperlipidemics and antiosteoporotics in the three European cohorts. However, the degree of variability in adherence rates among the three countries was high. A harmonized method of data extraction and analysis across health-related database in Europe is useful to compare medication-taking behavior at a cross-country level.


drug utilization; medication adherence; medication persistence; prescribing

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

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