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Understanding Processes, Outcomes, and Contexts in Medication Adherence: The Medication Adherence Context and
Rebecca J Bartlett Ellis1, Joan E Haase1, Todd M Ruppar2
1Science of Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA.
Patient Preference and Adherence
|January 31, 2023
Summary
The Medication Adherence Context and Outcomes (MACO) framework identifies specific processes within clinical, pharmacy, and home settings to improve medication adherence. This context-specific approach aids in developing targeted interventions for better patient outcomes.
Area of Science:
- Health Services Research
- Patient Adherence Studies
- Behavioral Science
Background:
- Poor medication adherence is a significant challenge, with current interventions often proving ineffective.
- Existing models lack a deep understanding of context-specific processes influencing adherence.
- A framework detailing these processes is crucial for targeted intervention development.
Purpose of the Study:
- To describe the Medication Adherence Context and Outcomes (MACO) framework.
- To outline context-specific processes (shared decision-making, prescription filling, home management) and their link to adherence outcomes (initiation, implementation, discontinuation, persistence).
Main Methods:
- Iterative development of the MACO framework from 2015-2018.
- Integration of theory, practice, research, and patient journey mapping.
- Chronological description of environmental contexts and actions contributing to adherence.
Main Results:
- The MACO framework identifies three key contexts: clinical encounters, pharmacy encounters, and home management.
- Specific processes within each context are linked to adherence outcomes.
- The framework distinguishes context-specific processes and outcomes.
Conclusions:
- The MACO framework offers a structured approach to understanding medication adherence challenges.
- It facilitates the development of context-specific interventions targeting underlying nonadherence processes.
- This framework aids in selecting appropriate adherence measures for different settings.
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