title: Strategies to Improve Medication Adherence in Older Persons: Consensus Statement from the Senior Italia Federanziani Advisory Board.
abstract: Poor adherence to treatment regimens has long been recognized as a substantial roadblock to achieving better outcomes for patients. Non-adherence to medications affects the quality and length of life and has been associated with negative health outcomes and increasing healthcare costs. The problem of non-adherence is particularly troublesome in older patients who are affected by multiple chronic diseases and for this reason receive multiple treatments. To date, no single intervention strategy has been shown to be effective in improving adherence across all patients, conditions, and settings. Between September and October 2014, a group of experts in geriatrics, pharmacology, epidemiology, and public health applied a modified RAND appropriateness method to reach a consensus on the possible best interventions to improve adherence in older individuals. Seven interventions were identified, classified based on their target (patient, therapy, and public health/society): (1) Comprehensive Geriatric Assessment, (2) patient (and caregiver) education to improve patient empowerment, (3) optimization of treatment, (4) use of adherence aids, (5) physician and other healthcare professionals' education, (6) adherence assessment, (7) facilitating access to medicine by service integration. For each intervention, experts assessed (a) target population, (b) health professionals potentially involved in the intervention, (c) strategies/instruments needed for implementation, and (d) time of the intervention. Interventions that target adherence must combine different approaches targeting the complex aspects of older adults in a holistic approach. Tackling non-adherence, with its complexity, requires a multi-stakeholder patient-centred approach acting in a defined framework of interactions in which the different players may provide different services but are integrated with one another.
authors.affiliation: Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy. alessandra.marengoni@unibs.it.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marengoni
authors.affiliation: Italian Medicines Agency, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Monaco
authors.affiliation: UCIBIO, REQUIMTE and Faculty of Pharmacy, University of Porto, Porto, Portugal.
authors.forename: Elisio
authors.initials: E
authors.lastname: Costa
authors.affiliation: Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Ancona, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cherubini
authors.affiliation: IIS Aragón, Aragon Health Sciences Institute (IACS), Zaragoza, Spain.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Prados-Torres
authors.affiliation: Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Muth
authors.affiliation: Department of Geriatric Medicine/Radboud Alzheimer Centre, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
authors.forename: Renè J F
authors.initials: RJ
authors.lastname: Melis
authors.affiliation: Laboratory for Quality Assessment of Geriatric Therapies and Services, Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pasina
authors.affiliation: Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.
authors.forename: Tischa J M
authors.initials: TJ
authors.lastname: van der Cammen
authors.affiliation: San Camillo IRCCS, Venice, Italy.
authors.forename: Katie
authors.initials: K
authors.lastname: Palmer
authors.affiliation: University of Brescia, Brescia, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Pecorelli
authors.affiliation: Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D032921:Consensus; D004358:Drug Therapy / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D004517:Education, Professional / Q000458:organization & administration; D015577:Geriatric Assessment; D006282:Health Personnel / Q000193:education; D006801:Humans; D007558:Italy; D008875:Middle Aged; D010353:Patient Education as Topic / Q000458:organization & administration; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards / Q000639:trends; D016903:Drug Monitoring