Standardizing terminology and definitions of medication adherence and persistence in research employing electronic databases

Med Care. 2013 Aug;51(8 Suppl 3):S11-21. doi: 10.1097/MLR.0b013e31829b1d2a.


Objective: To propose a unifying set of definitions for prescription adherence research utilizing electronic health record prescribing databases, prescription dispensing databases, and pharmacy claims databases and to provide a conceptual framework to operationalize these definitions consistently across studies.

Methods: We reviewed recent literature to identify definitions in electronic database studies of prescription-filling patterns for chronic oral medications. We then develop a conceptual model and propose standardized terminology and definitions to describe prescription-filling behavior from electronic databases.

Results: The conceptual model we propose defines 2 separate constructs: medication adherence and persistence. We define primary and secondary adherence as distinct subtypes of adherence. Metrics for estimating secondary adherence are discussed and critiqued, including a newer metric (New Prescription Medication Gap measure) that enables estimation of both primary and secondary adherence.

Discussion: Terminology currently used in prescription adherence research employing electronic databases lacks consistency. We propose a clear, consistent, broadly applicable conceptual model and terminology for such studies. The model and definitions facilitate research utilizing electronic medication prescribing, dispensing, and/or claims databases and encompasses the entire continuum of prescription-filling behavior.

Conclusion: Employing conceptually clear and consistent terminology to define medication adherence and persistence will facilitate future comparative effectiveness research and meta-analytic studies that utilize electronic prescription and dispensing records.

MeSH terms

  • Databases, Factual / statistics & numerical data
  • Electronic Health Records / organization & administration*
  • Electronic Health Records / statistics & numerical data*
  • Health Services Research
  • Humans
  • Insurance Claim Review / statistics & numerical data
  • Medication Adherence / statistics & numerical data*
  • Multicenter Studies as Topic / statistics & numerical data
  • Pharmaceutical Services / statistics & numerical data
  • Terminology as Topic*