A:CARE Research on Medication Adherence
A:CARE Research on Medication Adherence
Publications
At Abbott, we believe that solving the challenge of medication non-adherence requires a strong foundation in science. Through a:care, we support and publish research that explores the behavioral and psychological drivers of adherence, as well as the role of digital health tools in improving patient outcomes. These publications provide healthcare professionals with the knowledge needed to implement effective, evidence-based interventions.
1. Evaluating the effect of mobile applications “My A:Care” and “Smart Coach” on adherence to lipid-lowering treatment in patients with dyslipidemia: A prospective, randomized, open-label clinical study1
This proof-of-concept clinical study, conducted in Thailand and supported by Abbott through the a:care initiative, evaluated the impact of two mobile health applications – My A:Care and its enhanced version, Smart Coach – on medication adherence in patients with dyslipidemia.
Over a 12-week period, 150 patients with suboptimal adherence were randomized into three groups: My A:Care, Smart Coach, and a control group with no app. Both apps, grounded in behavioral science, offered features such as pill reminders, motivational messages, and personalized support. Smart Coach further incorporated tailored interventions using the SPUR behavioral framework.
The study found that both digital tools helped maintain adherence and showed favorable trends in lipid control, particularly in Non-HDL-C and LDL-C levels, compared to the control group. While results were modest, they suggest that behavioral science-based mobile apps may support better adherence in chronic disease management. These findings warrant further investigation in larger, long-term studies.
2. The silent epidemic of non-adherence: Insights from the 2024 a:care Congress2
This meeting report, published in BMC Proceedings and supported by Abbott through the a:care initiative, summarizes key insights from the 2024 a:care Congress, themed “Adherence is a Behavior: Do We Have the Right One?”. The congress brought together global experts to address the widespread challenge of medication non-adherence, which contributes to preventable deaths, hospitalizations, and rising healthcare costs worldwide.
The sessions explored the behavioral, systemic, and economic drivers of non-adherence, emphasizing the need for a multidisciplinary, patient-centered approach. Topics included the role of behavioral science, digital health tools, and artificial intelligence in improving adherence, as well as the importance of trust and communication in the patient–provider relationship.
The congress highlighted that improving adherence requires coordinated action from all healthcare stakeholders ; patients, providers, policymakers, and industry. The findings reinforce a:care’s mission to raise awareness, support behavioral change, and promote sustainable strategies to improve health outcomes globally.
3. Medication non-adherence: Definition, measurement, prevalence, and causes. Reflecting on the past 20 years and looking forwards3
This comprehensive review, published in Frontiers in Pharmacology and supported by Abbott, reflects on two decades of research into medication non-adherence, its definitions, measurement, prevalence, and causes. The authors argue for a shift from viewing adherence as a binary outcome to understanding it as a dynamic, behaviorally driven process that evolves over time.
The paper highlights that non-adherence is more prevalent than often reported, with up to 50% of patients not implementing treatment as prescribed and many discontinuing over time. It explores the growing role of behavioral science, digital health technologies, and big data in capturing more nuanced patterns of adherence. Frameworks like COM-B (Capability, Opportunity, Motivation) and MACO (Medication and Adherence Contexts and Outcomes) are emphasized for their ability to explain the complex, multifactorial nature of non-adherence.
The authors call for a paradigm shift in how healthcare systems, researchers, and clinicians approach adherence, moving toward personalized, data-driven interventions that address both practical and perceptual barriers to medication-taking behavior.
4. Projected cost savings with optimal medication adherence in patients with cardiovascular disease requiring lipid-lowering therapy: A multinational economic evaluation study4
Published in the Journal of the American Heart Association and supported by Abbott through the a:care program, this multinational economic evaluation study estimates the clinical and economic benefits of optimal medication adherence in patients with cardiovascular disease (CVD) requiring lipid-lowering therapy in Mexico, Thailand, and China.
Using a Markov model simulation, the study found that improving adherence could prevent 34 to 63 cardiovascular events per 1,000 patients over a lifetime, depending on the country. It also projected significant gains in life years and quality-adjusted life years (QALYs), along with cost savings of up to $700 per patient from a societal perspective.
The findings highlight that non-adherence leads to avoidable healthcare costs and poorer outcomes, especially in middle-income countries. The study supports the implementation of adherence-enhancing strategies, such as digital health tools, to improve outcomes and reduce the burden on healthcare systems.
Watch the featured session from the a:care Congress 2024 highlighting this study: https://acarepro.abbott.com/congress/congress-session/non-adherence-without-borders-cross-continent-perspectives-and-local-realities/
5. Proceedings from the a:care congress: Adherence to medication, time to recognise the elephant in the room
Published in Atherosclerosis and based on the 2021 a:care congress, this article – endorsed by the European Atherosclerosis Society – highlights the urgent need to address medication non-adherence as a critical and often overlooked healthcare issue.
The congress proceedings emphasize that up to 50% of medications for chronic conditions are not taken as prescribed, with significant consequences for patient outcomes and healthcare costs. The article explores the behavioral, professional, and systemic drivers of non-adherence, advocating for a multidisciplinary, behavioral science-based approach to improve uptake, implementation, and persistence with treatment.
Key frameworks discussed include COM-B (Capability, Opportunity, Motivation) and the Perceptions and Practicalities Approach (PAPA), which help tailor interventions to individual patient needs. The authors argue for hybrid digital-HCP solutions that go beyond reminders to address motivational and perceptual barriers, and call for greater awareness, training, and system-level accountability.
6. Clinicians’ view on non-adherence: Sharing expert opinion
This qualitative study, recently published in Frontiers of Pharmacology, explored the perspectives of seven international physicians on medication non-adherence through interviews and questionnaires across diverse specialties, including family medicine, gastroenterology, otolaryngology, otology and neurotology, obstetrics and gynecology, endocrinology, and cardiology.
The study outlined how physicians identify medication non-adherence and highlighted key barriers that varied by specialty. Strategies to improve medication adherence included patient education, shared decision-making, therapy simplification, digital tools, and team-based care. Nonetheless, systemic challenges—such as limited time, fragmented records, and insufficient tracking mechanisms—continued to hinder progress. The findings underscore the need for patient-centered, interdisciplinary approaches and larger-scale research to validate and expand adherence interventions.
This article was written with the assistance of generative AI technology and reviewed for accuracy.
Q&A
They show promise. A proof-of-concept clinical study in Thailand found that both the My A:Care and its extended version (Smart Coach) apps helped patients with dyslipidemia maintain adherence to lipid-lowering therapy over 12 weeks. The apps use behavioral nudges, reminders, and motivational content to support patients1.
It’s massive. Experts described non-adherence as a “silent epidemic” contributing to preventable deaths and healthcare costs. The congress emphasized that non-adherence is a system-wide issue, not just a patient problem2.
Adherence challenges are global but differ by region. For example, adherence rates in CVD are around 50% in Mexico and Thailand, but as low as 19% in China. These differences impact outcomes and healthcare costs4.
Absolutely. Modeling studies show that improving adherence to lipid-lowering therapy could save up to $700 per patient in China, $412 in Mexico, and $316 in Thailand, while also preventing cardiovascular events4.
The COM-B model (Capability, Opportunity, Motivation – Behavior) offers a useful framework. Motivation, in particular, is often the biggest barrier but can be improved with targeted behavioral interventions5.
We now see non-adherence as a dynamic, multifactorial behavior—not a fixed trait. Advances in digital tools, behavioral science, and big data have helped us better understand and address it3.
Digital tools like apps and electronic monitors can support adherence by providing reminders, tracking behavior, and even predicting risk of non-adherence. However, they work best when combined with human support3.
Beliefs and emotions play a big role. Patients may fear side effects, feel better and think they no longer need treatment, or struggle with daily routines. Addressing these perceptions is key to improving adherence1.
It’s substantial. In the U.S., non-adherence in CVD can cost between $3,000 and $19,000 per patient per year. In Europe, it’s linked to 200,000 premature deaths and €125 billion in annual costs5.
There’s no single gold standard. Self-reports, pharmacy refill data, electronic monitors, and biomarkers all have strengths and limitations. Combining methods often gives the most accurate picture3.