A review of measures used to examine medication adherence in people with ADHD at initiation, implementation and discontinuation of pharmacotherapy.

BACKGROUND

Adherence to prescribed medication is a dynamic process that changes over time. Whilst several measures have been used to examine adherence in patients with ADHD, it is not clear how these measures have been used to measure adherence in the context of its three phases (initiation, implementation, discontinuation).

OBJECTIVE

To examine measures used to assess medication adherence at its three phases in people with ADHD.

METHODS

The PRISMA guidelines were followed for this review. Six databases (Medline, PubMed, IPA, CINAHL, Embase, and PsycINFO) were systematically searched in October 2018, without any limitations on the start dates. Keywords reflecting three broad concepts (adherence, ADHD and measures) were used as part of the search strategy. Studies that assessed medication adherence in people with ADHD and described methods used to assess adherence were selected for this review.

RESULTS

Forty-nine studies were included. Most (69.3%) examined adherence at the implementation phase. Claims databases, self-reported questionnaires, and prescription-refill records were used to measure adherence at the initiation, implementation, and discontinuation phase, respectively. Overall, self-reported questionnaires were the most frequently used measure at the implementation phase, but the psychometric properties were not reported in almost half of the studies that used these measures.

CONCLUSIONS

Initiation and discontinuation phases of adherence have been relatively less examined in people with ADHD. Although self-reported questionnaires were the commonly used measures, the validity and reliability of these measures are of concern in guiding evidence-based practice. Measures with improved psychometric properties are needed that can examine adherence across its three phases.