International Journal of Clinical Pharmacy

, Volume 36, Issue 1, pp 202–211 | Cite as

The Aston Medication Adherence Study: mapping the adherence patterns of an inner-city population

  • Christopher A. LangleyEmail author
  • Joseph Bush
Research Article


Background The Aston Medication Adherence Study was designed to examine non-adherence to prescribed medicines within an inner-city population using general practice (GP) prescribing data. Objective To examine non-adherence patterns to prescribed oral medications within three chronic disease states and to compare differences in adherence levels between various patient groups to assist the routine identification of low adherence amongst patients within the Heart of Birmingham teaching Primary Care Trust (HoBtPCT). Setting Patients within the area covered by HoBtPCT (England) prescribed medication for dyslipidaemia, type-2 diabetes and hypothyroidism, between 2000 and 2010 inclusively. HoBtPCT’s population was disproportionately young, with seventy per cent of residents from Black and Minority Ethnic groups. Method Systematic computational analysis of all medication issue data from 76 GP surgeries dichotomised patients into two groups (adherent and non-adherent) for each pharmacotherapeutic agent within the treatment groups. Dichotomised groupings were further analysed by recorded patient demographics to identify predictors of lower adherence levels. Results were compared to an analysis of a self-report measure of adherence [using the Modified Morisky Scale© (MMAS-8)] and clinical value data (cholesterol values) from GP surgery records. Main outcome Adherence levels for different patient demographics, for patients within specific longterm treatment groups. Results Analysis within all three groups showed that for patients with the following characteristics, adherence levels were statistically lower than for others; patients: younger than 60 years of age; whose religion is coded as “Islam”; whose ethnicity is coded as one of the Asian groupings or as “Caribbean”, “Other Black” and “African”; whose primary language is coded as “Urdu” or “Bengali”; and whose postcodes indicate that they live within the most socioeconomically deprived areas of HoBtPCT. Statistically significant correlations between adherence status and results from the selfreport measure of adherence and of clinical value data analysis were found. Conclusion Using data from GP prescribing systems, a computerised tool to calculate individual adherence levels for oral pharmacotherapy for the treatment of diabetes, dyslipidaemia and hypothyroidism has been developed. The tool has been used to establish nonadherence levels within the three treatment groups and the demographic characteristics indicative of lower adherence levels, which in turn will enable the targeting of interventional support within HoBtPCT.


Diabetes Dyslipidaemia Hypothyroidism Medication adherence Modified Morisky Scale United Kingdom 



The authors are grateful to a range of individuals and organisations that made the project possible. In particular, the authors would like to highlight Jane E Harvey (Research Pharmacist), Alpa Patel (Research Administrator) and John Williams (Database analyst). In addition, the authors are grateful to members for the Project Steering Group. Thanks are offered to Professor Donald Morisky for permitting the use of the Modified Morisky Scale (MMAS-8) and the information provided regarding translation of this questionnaire. Further details on the individuals and organisations that helped with the study can be found within the project report [19].


Funding This study was funded by the Heart of Birmingham teaching Primary Care Trust R&D Programme (which is now part of NHS Birmingham and Solihull).

Conflicts of interest

The authors have no conflicts of interest to declare.


  1. 1.
    Nunes V, Neilson J, O’Flynn N, Calvert N, Kuntze S, Smithson H, et al. Clinical guidelines and evidence review for medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence. London: National Collaborating Centre for Primary Care and Royal College of General Practitioners; 2009.Google Scholar
  2. 2.
    Horne R, Weinman J, Barber N, Elliot R, Morgan M. Concordance, adherence and compliance in medicine-taking. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D; 2005.
  3. 3.
    Cramer JA, Mattson RH. Monitoring compliance with antiepileptic drug therapy. In Cramer JA, Spilker B, editors. Patient compliance in medical practice and clinical trials. New York: Raven Press; 1991. ISBN: 978-0-88167-735-5.Google Scholar
  4. 4.
    Spector SL, Kinsman R, Mawhinney H, Siegel SC, Rachelefsky GS, Katz RM, et al. Compliance of patients with asthma with an experimental aerosolized medication: implications for controlled clinical trials. J Allergy Clin Immunol. 1986;77:65–70.PubMedCrossRefGoogle Scholar
  5. 5.
    Straka RJ, Fish JT, Benson SR, Suh JT. Patient self-reporting of compliance does not correspond with electronic monitoring: an evaluation using isosorbide dinitrate as a model drug. Pharmacotherapy. 1997;17:126–32.PubMedGoogle Scholar
  6. 6.
    Zeller A, Ramseier E, Teagtmeyer A, Battegay E. Patients’ self-reported adherence to cardiovascular medication using electronic monitors as comparators. Hypertens Res. 2008;31:2037–43.PubMedCrossRefGoogle Scholar
  7. 7.
    Andrade SE, Kahler KH, Frech F, Chan KA. Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf. 2006;15(8):565–74.PubMedCrossRefGoogle Scholar
  8. 8.
    Copher R, Buzinec P, Zarotsky V, Kazis L, Iqbal SU, Macarios D. Physician perception of patient adherence compared to patient adherence of osteoporosis medications from pharmacy claims. Curr Med Res Opin. 2010;26:777–85.PubMedCrossRefGoogle Scholar
  9. 9.
    Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26:331–42.PubMedCrossRefGoogle Scholar
  10. 10.
    Mabotuwana T, Warren J, Harrison J, Kenealy T. What can primary care prescribing data tell us about individual adherence to long-term medication? Comparison to pharmacy dispensing data. Pharmacoepidemiol Drug Saf. 2009;18:956–64.PubMedCrossRefGoogle Scholar
  11. 11.
    Farley J, Hines S, Musk A, Ferrus S, Tepper V. Assessment of adherence to antiviral therapy in HIV-infected children using the medication event monitoring system, pharmacy refill, provider assessment, caregiver self-report, and appointment keeping. J Acquir Immune Defic Syndr. 2003;33:211–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;2(2):000011.Google Scholar
  13. 13.
    World Health Organisation. Adherence to long-term therapies: evidence for action. Geneva: World Health Organisation; 2003.Google Scholar
  14. 14.
    Heart of Birmingham teaching Primary Care Trust. Annual report 2009–2010. Birmingham: Heart of Birmingham teaching Primary Care Trust; 2010.Google Scholar
  15. 15.
    Heart of Birmingham teaching Primary Care Trust. Public health report 2009–2010. Birmingham: Heart of Birmingham teaching Primary Care Trust; 2010.Google Scholar
  16. 16.
    Office for National Statistics. 2001 census: census area statistics: religion: heart of Birmingham (Primary Care Organisation). Available from (2012). Accessed 3 June 2013.
  17. 17.
    Health Protection Agency. HPA profile—heart of Birmingham teaching. Available from (2012). Accessed 18 Apr 2012.
  18. 18.
    Krousel-Wood M, Islam T, Webber L, Re R, Morisky D, Muntner P. New medication adherence scale versus pharmacy fill rates in seniors with hypertension. Am J Manag Care. 2009;15:59–66.PubMedCentralPubMedGoogle Scholar
  19. 19.
    Langley C, Bush J, Harvey J, Patel A, Marriott J. Establishing the extent of patient non-adherence to prescribed medication in the Heart of Birmingham teaching Primary Care Trust (HoBtPCT). The Aston Medication Adherence Study (AMAS). Report commissioned by the Heart of Birmingham teaching Primary Care Trust; 2012.Google Scholar
  20. 20.
    Burkhart P, Dunbar-Jacob J. Adherence research in the pediatric and adolescent populations: a decade in review. In Hayman L, Mahom M, Turner R, editors. Chronic illness in children: an evidence-based approach. New York: Springer; 2002. ISBN: 978-0-82613-856-9.Google Scholar
  21. 21.
    Fotheringham MJ, Sawyer MG. Adherence to recommended medical regimens in childhood and adolescence. J Paediatr Child Health. 1995;31:72–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Morris AB, Li J, Kroenke K, Bruner-England TE, Young JM, Murray MD. Factors associated with drug adherence and blood pressure control in patients with hypertension. Pharmacotherapy. 2006;26:483–92.PubMedCrossRefGoogle Scholar
  23. 23.
    Shaya FT, Du D, Gbarayor CM, Frech-Tamas F, Lau H, Weir MR. Predictors of compliance with antihypertensive therapy in a high-risk medicaid population. J Natl Med Assoc. 2009;101:34–9.PubMedGoogle Scholar
  24. 24.
    Walker EA, Molitch M, Kramer MK, Kahn S, Ma Y, Edelstein S, Smith K, et al. Adherence to preventive medications: predictors and outcomes in the Diabetes Prevention Program. Diabetes Care. 2006;29:1997–2002.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Charles H, Good CB, Hanusa BH, Chang CC, Whittle J. Racial differences in adherence to cardiac medications. J Natl Med Assoc. 2003;95:17–27.PubMedGoogle Scholar
  26. 26.
    Briesacher BA, Andrade SE, Fouayzi H, Chan KA. Comparison of drug adherence rates among patients with seven different medical conditions. Pharmacotherapy. 2008;28:437–43.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Natarajan N, Putnam RW, Yip AM, Frail D. Family practice patients’ adherence to statin medications. Can Fam Physician. 2007;53:2144–5.PubMedCentralPubMedGoogle Scholar
  28. 28.
    Rozenfeld Y, Hunt JS, Plauschinat C, Wong KS. Oral antidiabetic medication adherence and glycemic control in managed care. Am J Manag Care. 2008;14:71–5.PubMedGoogle Scholar
  29. 29.
    Bashir A, Asif M, Lacey FM, Langley CA, Marriott JF, Wilson KA. Concordance in muslim patients in primary care. Int J Pharm Pract. 2001;9:R78.CrossRefGoogle Scholar
  30. 30.
    Nichol MB, Knight TK, Wu J, Tang SS, Cherry SB, Benner JS, Hussein M. Transition probabilities and predictors of adherence in a California medicaid population using antihypertensive and lipid-lowering medications. Value Health. 2009;12(4):544–50.PubMedCrossRefGoogle Scholar
  31. 31.
    Schectman JM, Bovbjerg VE, Voss JD. Predictors of medication-refill adherence in an indigent rural population. Med Care. 2002;40:1294–300.PubMedCrossRefGoogle Scholar
  32. 32.
    Wu JR, Moser DK, Chung ML, Lennie TA. Predictors of medication adherence using a multidimensional adherence model in patients with heart failure. J Card Fail. 2008;14:603–14.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Lawton J, Ahmad N, Hallowell N, Hanna L, Douglas M. Perceptions and experiences of taking oral hypoglycaemic agents among people of Pakistani and Indian origin: qualitative study. BMJ. 2005;330:1247.PubMedCrossRefGoogle Scholar
  34. 34.
    Shenolikar RA, Balkrishnan R, Camacho FT, Whitmire JT, Anderson RT. Race and medication adherence in medicaid enrollees with type-2 diabetes. J Natl Med Assoc. 2006;98:1071–7.PubMedGoogle Scholar
  35. 35.
    Trinacty CM, Adams AS, Soumerai SB, Zhang F, Meigs JB, Piette JD, et al. Racial differences in long-term adherence to oral antidiabetic drug therapy: a longitudinal cohort study. BMC Health Serv Res. 2009;9:24.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Adams AS, Trinacty CM, Zhang F, Kleinman K, Grant RW, Meigs JB, et al. Medication adherence and racial differences in A1C control. Diabetes Care. 2008;31:916–21.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA. 2002;288:455–61.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  1. 1.School of PharmacyAston UniversityBirminghamUK

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