New study validates a:care insight’s SPUR algorithm for chronic medication adherence

• Medication non-adherence contributes to poor health outcomes, higher healthcare costs, and increased mortality in patients with chronic diseases.^1,2,3
• Abbott’s a:care Insight, powered by the SPUR algorithm, creates personalized adherence profiles by analyzing social, psychological, usage, and rational factors.^4,5
• A 2025 study validated SPUR across multiple diseases and countries, showing strong predictive power for real-world outcomes like HbA1c levels and refill rates.

The silent epidemic of medication non-adherence

Medication non-adherence is often dubbed a “silent epidemic” in healthcare – a global problem leading to hundreds of thousands of preventable deaths and avoidable hospitalizations each year.^1,2 In long-term conditions like cardiovascular disease, failing to take medications as prescribed drastically worsens outcomes. Even a 20% improvement in adherence is associated with an 8% reduction in serious cardiovascular events and a 12% decrease in mortality.⁶ Poor adherence also fuels complications in diseases such as osteoporosis, where patients with low medication adherence have significantly higher fracture rates than those who follow their therapy.² These facts underscore why improving adherence is critical for chronic disease management and why healthcare providers (HCPs) are seeking better tools to address it.

Introducing the SPUR adherence profiling tool

To tackle this challenge, Abbott’s a:care program developed a:care insight, a digital risk calculator powered by the SPUR algorithm. SPUR stands for Social, Psychological, Usage, and Rational, the four domains of patient behavior that drive medication-taking behavior.^4,5 The SPUR tool is a brief adaptive questionnaire capturing 13 key patient-level drivers behind non-adherence. By quantifying factors ranging from social support and beliefs about medication to daily routines and cost concerns, SPUR provides a holistic “adherence profile” for each patient.⁴ Tools like SPUR help healthcare professionals understand why a patient may not follow their treatment—whether it’s due to practical issues like forgetfulness or deeper concerns like identity or resistance to authority. Instead of relying only on what patients say, SPUR reveals underlying behavioral patterns. This allows clinicians to tailor support more effectively, addressing both the visible and hidden reasons behind nonadherence.⁴

New 2025 evidence validates SPUR’s effectiveness

A newly published 2025 Scientific Reports study⁴ offers robust evidence that SPUR accurately predicts medication adherence across diverse patient populations. Key findings include:

• Validated across diseases: Researchers pooled data from five cohorts in three countries (including patients with type 2 diabetes, chronic obstructive pulmonary disease, and cardiovascular disease) and found that SPUR’s short form (6 items) and full form (24 items) have shown strong predictive value in identifying patients at risk of non-adherence, outperforming their earlier versions as well as other commonly used adherence assessment tools across various countries and medical conditions.⁴ This cross-cohort validation confirms the tool’s generalizability across different chronic conditions.
• Predictive power: Higher SPUR scores correlate with better real-world outcomes. For example, in diabetes patients, higher SPUR-27 scores were significantly associated with lower HbA1c levels and higher medication possession ratios (refill rates).⁴ In other words, the SPUR profile not only matches traditional questionnaires but also reflects objective health indicators – a strong sign of validity.
• Behavioral insights: Advanced analysis (structural equation modelling) in the study revealed not only the relative influence of different behavioral drivers but also their interconnected nature, offering valuable insights for designing effective behavioral interventions. In plain terms, how a patient feels and thinks about their illness (e.g. trust, motivation, mental state) can shape whether they remember and choose to take medication as directed. These findings highlight the importance of addressing upstream drivers like beliefs and emotions, not just the act of pill-taking itself.⁴ Such insights have direct implications for communication strategies, reinforcing that improving adherence requires both educating the patient and building trust and support around them.

Implications for chronic disease management

For clinicians managing chronic conditions, this validation of the SPUR-powered a:care Insight tool is a welcome development. It means HCPs can confidently use a simple digital questionnaire to flag patients who might be struggling with adherence, and then intervene proactively. By pinpointing the specific barriers each patient faces, whether it’s a forgetful routine (usage issue) or skepticism about treatment (psychological barrier), providers can personalize their care approach. Research shows that even modest adherence gains yield significant health benefits: for instance, improving medication adherence can prevent a substantial number of heart attacks and deaths in heart disease,⁶ and in osteoporosis patients it markedly lowers the risk of potentially disabling fractures.² The newly validated SPUR framework empowers HCPs to deliver these improvements by addressing the human factors behind the pills. In turn, this evidence-based, behavior-focused approach to adherence is poised to enhance long-term outcomes and quality of life for patients with chronic diseases.

More information about a:care insight: https://acarepro.abbott.com/tools/acare-insight/.⁹

This article was written with the assistance of generative AI technology and reviewed for accuracy.