Medication Adherence Interventions for Older Adults: A National Mixed-Methods Study of Implementation Across Italian...

Medication non-adherence is common among older adults and represents a major challenge for healthcare systems. Effective interventions are needed to support adherence and inform quality-improvement efforts.

To assess how medication-adherence interventions for older adults are currently implemented in Italy and to identify care-delivery priorities improving quality and feasibility across healthcare settings.

We conducted a mixed-methods study within the Eldercare project. We administered a national benchmarking survey (May-August 2024) to healthcare professionals and patient representatives from scientific societies, professional orders, public institutions, universities, and patient associations. We ran a nested Strengths, Weaknesses, Opportunities and Threats (SWOT) survey (January-March 2025) with key informants. We summarized quantitative responses, compared distributions across professional roles (χ²/Fisher's exact tests), and analyzed SWOT free-text using a hybrid deductive-inductive Framework Method.

In the benchmarking survey (n = 340), Respondents reported that adherence is mainly addressed during routine consultations (78.5%) and most often relied on direct patient-provider communication (51.5%). Respondents reported that monitoring is primarily based on clinical data (55.3%) and access to dispensing/prescription data and digital tools was less frequent (generally ≤ 50%). Respondents rated patient-centered strategies as highly important (e.g., caregiver involvement 94.4%, shared goal setting 90.3%, individual counseling 87.6%), but feasibility ratings were consistently lower. The most frequently reported unmet needs were limited patient awareness (68.8%) and poor coordination among professionals (60.3%). Key barriers included high numbers of daily medicines (69.1%) and lack of clear information on prescribed therapies (64.7%). In the SWOT survey (n = 14), strengths included continuity and communication, while weaknesses and threats focused on fragmented interprofessional collaboration, limited training, low digitalisation, and scarce financial/institutional support.

Medication-adherence support for older adults in Italy remains largely consultation-based and variably resourced. Strengthening interprofessional coordination, training, and use of digital/administrative data may help develop more structured and scalable adherence-support pathways as a quality-improvement model of care.