title: Medication adherence: A practical measurement selection guide using case studies.
abstract: OBJECTIVE
  Medication adherence is a complex problem and can be evaluated using a variety of methods. There is no single or perfect strategy to assess adherence. The "best" measure depends on contextual factors. Our objective is to provide a practical, illustrative guide for selecting the most appropriate measure of medication adherence in common contexts.
  
  
  METHODS
  We present three case studies - from the perspectives of an academic researcher, health care payer, and clinical care provider - to describe common problems and processes for measuring medication adherence, as well as proposing possible solutions.
  
  
  RESULTS
  The most appropriate measure will depend on the context (tightly controlled clinical trial setting vs. clinical setting), intended purpose (research vs. clinical), available resources (data, personnel, materials, and funding), time (quick screening vs. comprehensive review), and phase of interest (initiation, implementation, or discontinuation). Framing the problem of medication non-adherence and methods for measuring adherence are discussed using three representative case studies.
  
  
  CONCLUSIONS
  A simple tool is provided that may help stakeholders interested in medication adherence make decisions regarding the appropriate selection of measures.
  
  
  CONCLUSIONS
  A medication adherence measure should be selected through the lens of each situation's unique objectives, resources, and needs.
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA. Electronic address: leah.zullig@duke.edu.
authors.forename: Leah L
authors.initials: LL
authors.lastname: Zullig
authors.affiliation: Pfizer Inc. Medical Affairs, New York, NY, USA. Electronic address: phil.mendys@pfizer.com.
authors.forename: Phil
authors.initials: P
authors.lastname: Mendys
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA; School of Nursing, Duke University, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA. Electronic address: boswo001@mc.duke.edu.
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
mesh_terms: D017408:Guidelines as Topic; D006801:Humans; D055118:Medication Adherence
keywords: Case studies; Measurement; Medication adherence