Technology applied to geriatric medicine Adherence measurement systems and technology for medications in older patient populations S. Stegemann a, *, J.-P. Baeyens b , F. Cerreta c,1 , E. Chanie d , A. Lo ¨ fgren e , M. Maio f , G. Schreier g , E. Thesing-Bleck h a Capsugel, Rijskweg 11, B-2880 Bornem, Belgium b EUGMS, Generaal Jungbluthlaan 11, B-8400 Oostende, Belgium c European Medicines Agency, 7, Westferry Circus, Carnary Wharf, London E14 4HB, UK d Merck-Serono, 9, chemin des Mines, Case postale 54, CH-1211, Geneva 20, Switzerland e AstraZeneca, SE-15185 Sodertalje, Sweden f Merck KgaA, Frankfurter Str. 250, D-64293 Darmstadt, Germany g AIT Austrian Institute for Technology GmbH, Reininghausstr. 13/1, A-8020 Graz, Austria h ConceptionApo, Hander Weg 25B, 52072 Aachen, Germany 1. Introduction When new drugs are approved for human use, they have been extensively tested in the patient populations according to a defined regimen with regard to dose and time to establish their efficacy and safety profile. Based on these data, drugs are prescribed to patients with recommendations regarding the therapeutic sched- ule of the prescription. Patients are requested to use this information received along with the drug to include the therapy into their individual treatment schedule and manage adherently. However, until today only a minority of clinical trial patients are real older, comorbid and frail patients taking several additional drugs simultaneously (polypharmacy) [1,2]. This limitation makes it even more difficult for elderly patients to maintain ‘‘adherence’’ to therapy, since this patient population group is not properly considered when the medication system is being developed. Adherence is defined as the degree to which patient behaviors coincide with the healthcare providers and patients jointly agreed healthcare objectives and respective therapeutic regimen [3]. In contrast to compliance, adherence is not purely a physicians’ directive treatment plan; instead it includes an active and voluntary role of the patient and the acceptance to the prescribed therapy and therapeutic schedule. Beside the adherence, which is focusing on the correct daily dosing over time, persistence is a term used to describe the continuation of the therapy over the prescribed period [4,5]. Concordance has been introduced as another concept in which the decision about the drug therapy is commonly agreed between the physician and the patient after negotiations that respect the patient’s own wishes and beliefs [6]. Adherence to a prescribed drug therapy has a major influence on the therapeutic outcomes and the efficiency of the healthcare system. Coronary heart disease patients with self-reported non- adherence had 2-fold higher risk for fatal cardiovascular events compared to patients with self-reported good adherence [7]. Non- adherence has been found to cause direct costs of 100 billion USD and indirect costs of 1.5 billion USD plus 50 billion USD for patients earning losses and productivity losses, respectively [8]. Other studies confirmed significantly higher treatment costs caused by non-adherence due to an increased rate of therapeutic failure and an increase in hospitalization costs in patients with manic/mixed European Geriatric Medicine 3 (2012) 254–260 A R T I C L E I N F O Article history: Received 19 March 2012 Accepted 18 May 2012 Available online 4 July 2012 Keywords: Adherence measurement systems Older patients Drug adherence Improving drug adherence Reasons for non-adherence A B S T R A C T Non-adherence to a drug therapy is often the reason for not achieving the therapeutic goals in patients. Measuring drug adherence is an important intervention to understand patients’ adherence patterns and behavior as well as to provide supportive measures to enhance the patient adherence to a prescribed drug therapy. A variety of different adherence measurement systems (AMS) exist that have been proven valid even though there is not one single AMS considered to be a gold standard. Some AMS allow through interactions with the physician or pharmacist and the patient to initiate corrective interventions, mainly in the form of alert and reminder systems. When applied to patients with several morbidities, co- morbidities and disabilities, appropriate AMS still remain a challenge. ß 2012 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved. * Corresponding author. E-mail address: sven.stegemann@capsugel.com (S. Stegemann). 1 The views expressed in this article are the personal views of the author(s) and may not be understood or quoted as being made on behalf of or reflecting the position of the European Medicines Agency or one of its committees or working parties. The cooperation with the co-authors is within the remit of the EMA participation as observer to the work of the Geriatric Medicines Initiative. Available online at www.sciencedirect.com 1878-7649/$ – see front matter ß 2012 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved. http://dx.doi.org/10.1016/j.eurger.2012.05.004