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Patient Prefer Adherence. 2017 Jun 2;11:1009-1017. doi: 10.2147/PPA.S127131. eCollection 2017.

Coming full circle in the measurement of medication adherence: opportunities and implications for health care.

Author information

VP, Global Quality, External and Regulatory Affairs, MWV Healthcare, Richmond, VA, USA.
WestRock Healthcare, Visé, Belgium.
Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC.
Center for Observational and Real World Evidence, Merck, Rahway, NJ and Weill Medical College of Cornell University, New York, NY.
Division of General Internal Medicine, Duke University School of Medicine.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System.
Duke University School of Nursing.
Heart Center Nursing Research Program, Duke University Health System, Durham, NC, USA.


There is little debate that medication nonadherence is a major public health issue and that measuring nonadherence is a crucial step toward improving it. Moreover, while measuring adherence is becoming both more feasible and more common in the era of electronic information, the reliability and usefulness of various measurements of adherence have not been well established. This paper outlines the most commonly used measures of adherence and discusses the advantages and disadvantages of each that depend on the purpose for which the measure will be used. International consensus statements on definitions and guidelines for selection and use of medication adherence measures were reviewed. The quality of recommended measures was evaluated in selected publications from 2009 to 2014. The most robust medication adherence measures are often ill suited for large-scale use. Less robust measures were found to be commonly misapplied and subsequently misinterpreted in population-level analyses. Adherence assessment and measurement were rarely integrated into standard patient care practice patterns. Successful scalable and impactful strategies to improve medication adherence will depend on understanding how to efficiently and effectively measure adherence.


adherence measures; medication adherence; patient-reported outcomes; research methods; study design

Conflict of interest statement

Disclosure Dr Zullig is supported by a VA Health Services Research and Development (HSR&D) Career Development Award (CDA 13–025). Dr Bosworth is supported by a Research Career Scientist Award from VA Health Service Research and Development (VA HSR&D 08–27). The authors report no other conflicts of interest in this work.

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