Saturday, October 31, 2026

10:30 - 12:00

Lecture Theatre 5

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Medication adherence is a key driver of treatment effectiveness in chronic disease management, yet there is considerable variation in how it is measured and reported across qualitative and quantitative methods. The limited integration of these approaches constrains our ability to fully capture and interpret the complex, nuanced patterns of medication-taking behaviour. This symposium will be include the following six complementary presentations from emerging leaders in medication adherence research: 1. Introduction to medication adherence: theory and frameworks Presented by Dr Stella Talic (Head: PharmacoEpidemiology Group, School of Public Health and Preventive Medicine, Monash University) This presentation will cover how medication adherence is often simplified to a binary measure of “adherent” versus “non-adherent,” despite being a complex and evolving behaviour shaped by multiple interacting influences. Drawing on the WHO’s multidimensional framework, it will highlight how adherence varies over time and across patient, treatment, and healthcare contexts, and why traditional static measures can miss important patterns. By showcasing how pharmacoepidemiological approaches can better capture this complexity, the session aims to shift the focus from simply measuring adherence to understanding the people, behaviours, and systems that drive it, ultimately supporting more targeted and meaningful interventions. 2. Hidden Stories of Adherence: What Qualitative Research Reveals Presented by Caroline Trin (PharmacoEpidemiology Group, School of Public Health and Preventive Medicine, Monash University) This presentation will cover how qualitative pharmacoepidemiological methods can deepen our understanding of medication adherence by moving beyond simple classifications to explore the reasons and contexts behind patient behaviour. Using a real-world qualitative evidence synthesis example, it will highlight how diverse patient experiences—across underserved, rural, and cardiovascular populations—reveal both shared and unique barriers and enablers to adherence. The session will also examine commonly used self-reported adherence measures and their limitations, emphasizing the need to move beyond single thresholds to capture meaningful behavioural differences. By demonstrating how qualitative research uncovers relationships between barriers and enablers, and by highlighting the importance of consumer engagement, this presentation will show how incorporating patient perspectives can generate richer, more actionable insights to inform patient-centred research, policy, and practice. 3. Quantifying Medication Adherence: Methods, Metrics, and Methodological Challenges Presented by Dr Lachlan Dalli (Big Data, Epidemiology and Prevention Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University) This presentation will provide an overview of commonly used quantitative methods to evaluate medication use in chronic disease research, including measures of initiation, persistence, discontinuation, and adherence derived from administrative and dispensing data. Particular focus will be given to widely applied adherence metrics such as the Proportion of Days Covered (PDC) and Medication Possession Ratio (MPR), highlighting their assumptions, strengths, and limitations in capturing real-world medication-taking behavior. The session will then introduce the TEN-SPIDERS framework (presented by Lachlan), a structured approach designed to enhance the rigor, transparency, and reporting of pharmacoepidemiological studies of medication use. Together, this overview will equip participants with a clearer understanding of standard quantitative approaches and emerging frameworks to improve consistency and interpretability in medication adherence research. 4. Case example: Development and application of the TEN-SPIDERS package to measure medication adherence Presented by Dr Adam Livori (Grampian’s Health; Baker Heart and Diabetes Institute) This presentation will cover an interactive and practical approach to improving the consistency and transparency of medication adherence measurement. It will begin with a hands-on exercise where participants define key variables in a study of post-MI statin and antiplatelet use, highlighting variation in real-time across the audience. It will then introduce the need for standardisation, drawing on evidence from a large scoping review that revealed substantial heterogeneity in PDC methodologies, and present the TEN-SPIDERS framework as a structured solution. Finally, the session will demonstrate the development and application of the open-source TEN-SPIDERS Stata tool, showcasing how it enables flexible, reproducible, and transparent adherence calculations using pharmaceutical claims data. 5. Moving from summary adherence measures to longitudinal and dynamic measures of adherence Presented by Harvey Koh (PharmacoEpidemiology Group, School of Public Health and Preventive Medicine, Monash University) This presentation will cover the limitations of traditional summary measures (e.g.PDC), highlighting how reducing adherence to a single value can obscure meaningful differences in patient behaviour over time. It will introduce adherence as a dynamic, longitudinal phenomenon and present three complementary analytical approaches—Group-Based Trajectory Analysis (GBTA), process mining, and Hidden Markov Models (HMMs)—to better capture patterns, transitions, and changes in medication use. The session will also demonstrate how these methods can be integrated within the BRIDGE framework to generate clinically meaningful adherence phenotypes, offering a more nuanced and actionable understanding of medication-taking behaviour beyond conventional metrics. 6. Understanding medication adherence at the population level: Insight from Indonesia’s national health survey Presented by Lubna Farhana (Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran) This presentation will demonstrate how national health survey data can be leveraged to identify determinants of medication adherence among patients with chronic diseases in low- and middle-income countries. Using evidence from the Indonesia Health Survey (IHS), it will explore patient-, disease-, therapy-, and health system-related factors associated with medication adherence. The presentation will also discuss the strengths and limitations of using national survey data for medication adherence research and highlight how population-level evidence can support the development of targeted and tailored interventions at improving medication adherence in resource-constrained settings. Learning objectives: 1. To understand medication adherence as a complex, dynamic and multifaceted behaviour, and recognise its implications for patient outcomes, healthcare delivery, and policy. 2. Evaluate how qualitative pharmacoepidemiological approaches can be used to understand the complex and dynamic nature of medication adherence, identify barriers and enablers across diverse populations, and inform patient-centred research and interventions. 3. To understand key sources of variation in PDC calculations and how methodological choices—such as survival adjustment, switching, pre-supply, dose assumptions, and hospital stays—can influence adherence estimates and classification, highlighting the need for standardised reporting. 4. To describe the TEN-SPIDERS framework parameters and demonstrate how these can be operationalised using open-source Stata code and package applied to linked PBS administrative dispensing data. 5. To understand and apply dynamic, longitudinal methods for measuring medication adherence, and to interpret how different analytical approaches can reveal clinically meaningful patterns beyond traditional summary metrics. 6. To understand the determinants of medication adherence in the Indonesian context using nationally representative health survey data and explore their implications for intervention development.

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