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Medication Adherence Measurement in Southeast Europe: A Comparative Analysis of Assessment Methods, Digital Health
Dijana Miceva1, Răzvan Nicolae Rusu2, Veronica Bild2
1Faculty of Medical Sciences, Goce Delcev University, Krste Misirkov Str., No. 10-A, P.O. Box 201, 2000 Stip, North Macedonia.
Healthcare (Basel, Switzerland)
|August 13, 2026
Summary
Medication adherence monitoring is inconsistently integrated into routine care across Bulgaria, North Macedonia, Romania, and Serbia. Fragmented implementation stems from varied regulations and lack of standardized approaches, hindering effective medication management.
Area of Science:
- Health Services Research
- Pharmaceutical Policy
- Digital Health
Background:
- Medication adherence significantly impacts treatment outcomes but faces measurement and integration challenges in healthcare.
- Existing digital health infrastructure offers potential for improved adherence monitoring.
- Variations in digital health maturity and regulatory frameworks exist across European countries.
Purpose of the Study:
- To compare medication adherence measurement methods used in research and healthcare systems.
- To analyze legal and regulatory frameworks for adherence tools in North Macedonia, Romania, Serbia, and Bulgaria.
- To identify barriers and facilitators for systematic medication adherence monitoring.
Main Methods:
- A structured, comparative two-phase document review (January-April 2026).
- Searches of scientific databases (PubMed, Scopus, Web of Science) and official governmental/regulatory websites.
- Analysis of 84 documents including scientific publications and legal/policy documents.
Main Results:
- Medication adherence monitoring is not systematically integrated into routine practice in North Macedonia, Romania, and Bulgaria.
- Traditional indirect methods (e.g., refill data, clinician assessment) are more common than direct or digital methods.
- Regulatory frameworks for adherence tools vary significantly, impacting implementation and alignment with European digital health policies.
Conclusions:
- Implementation of systematic medication adherence monitoring is fragmented due to limited interoperability, inconsistent regulatory support, and lack of standardized national approaches.
- Strengthening regulatory guidance, harmonizing measurement standards, and integrating adherence indicators are crucial.
- Supporting pharmacist-led adherence services can enhance medication management.
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