Seeing the Forest Through the Trees: Improving Adherence Alone Will Not Optimize Medication Use

Area of Science:

• Health Services Research
• Medication Management
• Patient-Centered Care

Background:

• Medication adherence is a key focus in healthcare quality measurement.
• Current quality metrics often neglect patient-specific factors like clinical status or social situations.
• Nonadherence can stem from issues beyond simply not taking medication as prescribed.

Purpose of the Study:

• To highlight the limitations of current medication adherence quality measures.
• To advocate for a more comprehensive assessment of medication-related problems.
• To emphasize the importance of patient-centered factors in medication management.

Main Methods:

• Literature review and analysis of current quality metrics for medication adherence.
• Discussion of common medication-related problems beyond nonadherence.
• Conceptual framework for evaluating medication use in patient-centered contexts.

Main Results:

• Current adherence metrics, like proportion of days covered, are insufficient.
• More frequent medication problems include incorrect prescriptions or suboptimal dosing.
• Focusing solely on adherence without considering indication, efficacy, and safety can cause harm.

Conclusions:

• Quality measures must evolve to incorporate patient-centered issues for effective medication management.
• Addressing the full spectrum of medication-related problems is crucial for achieving the Triple Aim of healthcare.
• Leadership and advocacy are needed to broaden the scope of medication quality measurement.