Medication adherence interventions: where are we and where do we go?

• Published in: European journal of hospital pharmacy. Science and practice p. ejhpharm-2025-004650
• Main Authors: Eriksson, Tommy, Midlöv, Patrik
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 24.07.2025; BMJ Publishing Group LTD
• Subjects: Annan klinisk medicin; Artificial intelligence; Cardiovascular disease; Chronic illnesses; Clinical Medicine; Clinical outcomes; Cost control; Drug therapy; Editorial; Klinisk medicin; Medical and Health Sciences; MEDICATION ERRORS; Medicin och hälsovetenskap; Mortality; Other Clinical Medicine; Patient compliance; PATIENT SAFETY; PHARMACISTS; Pictographs; PREVENTIVE MEDICINE; PUBLIC HEALTH; Quality of Health Care; Systematic review; PUBLIC HEALTH; PREVENTIVE MEDICINE; PHARMACISTS; MEDICATION ERRORS; PATIENT SAFETY; Quality of Health Care
• ISSN: 2047-9956; 2047-9964; 2047-9964
• DOI: 10.1136/ejhpharm-2025-004650

Correspondence to Professor Tommy Eriksson; tommy.eriksson@mau.se Decades ago, WHO identified low adherence (defined as the extent to which a person’s behaviour regarding medication corresponds with agreed recommendations from a healthcare provider) to medications for chronic illnesses as a significant societal challenge, emphasising that fewer than 50% of people adhere to their medication regimens.1 In one of the largest studies on the subject, the authors concluded that the long-term survival benefits associated with improved drug adherence appear to be class specific, suggesting that adherence improvements are influenced by patients' overall behaviour ‘healthy adherer’ and drug effects.2 In another study, the authors found that improving antidiabetic medication adherence could reduce the risk of cardiovascular disease and long-term all-cause mortality.3 These findings align with WHO’s assertion that ‘the increased effectiveness of adherence interventions may have a far greater impact on the health of the population than any other specific medical treatment’.1 What has happened since? Several systematic reviews on different aspects of medication adherence enhancing interventions (MAEIs) have been published and reviewed.4–6 A recent study showed that addressing medication adherence has the potential to reduce annual healthcare costs in the USA by $100 to $300 billion, and morbidity and mortality associated with poor medication adherence costs by $528.4 billion annually.7 Artificial intelligence and tools for developing personalised adherence strategies, including apps, are growing, but there is limited evidence for their role in improving adherence, and health outcomes are weak.8 9 Also, the evidence available is generally not of high quality and studies varied greatly in terms of their study design, app features and outcome measures. [...]it is difficult to definitively draw conclusions regarding the impact of apps on medication adherence and whether improvements in adherence translate into improvements in clinical outcomes/patient-reported outcome measures (PROMs).9 As stated, information and communication are crucial for a person-centred approach. To aid in the knowledge and recall of drug-related information, as well as outlining specific medication adherence outcomes, pictograms can be used for patients with chronic conditions to move beyond the traditional didactic methods of oral and verbal communication about medication-taking behaviour, especially for those with lower health literacy.10 Why have MAEIs not been implemented and reimbursed systematically? A systematic review of outcomes for assessment of MAEIs evaluated 291 studies.11 The number of identified interventions was 326, 143 were behavioural interventions, including reminders, adherence monitorig, and follow-up, 110 were educational interventios, and 73 were mixed-method interventions.