The Medication Adherence Context and Outcomes Framework Image

Abstract

Background: Adherence interventions have been largely ineffective, with most taking a "one-size-fits-all” approach without consideration of reasons for nonadherence. While the ABC Taxonomy clarified terminology and identified various outcomes measured along the process continuum, intervention design requires understanding the environments and contexts that contribute to nonadherence. A framework that combines the understanding of environment contextual influences, processes, and outcomes is needed to move forward with approaches to intervention design. Methods: Developed based on theory, practice, and research, the Medication-management and Adherence Contexts and Outcomes (MACO) framework describes the environmental contexts, the processes that occur within the contexts, and how these processes contribute to adherence outcomes. The MACO framework differentiates the processes, defined as medication management, within and across contexts that affect adherence outcomes. Results: Three distinct yet interrelated contexts identified in the MACO framework include 1.) clinic, 2.) pharmacy, and 3.) home. Conclusions: The MACO framework is a useful heuristic to understand at which point people experience problems with managing medications in the medication management continuum. This information can then be used for designing and delivering context-specific interventions and selecting appropriate outcome measures of adherence based on the contexts.