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We also wanted to design a tool suitable for any treatment context, and able to assess adherence for each medication taken by patients.

After a review of the literature, a working group composed of a medical resident (CC), two general practitioners (SS and V-TT) and a professor of epidemiology (PR) drafted five questions related to (1) early discontinuation of the drug; (2) systematic omission of a daily dose (eg, at noon); (3) drug holidays; (4) skipping doses and (5) schedule errors.

To elaborate the items of the tool, we used the results from three systematic reviews6 21 completed by a search in MEDLINE via Pub Med for recent studies describing medication adherence and questionnaires to assess it.Then investigators performed a double interview method: they asked participants to explain what each item meant to them and why they chose a particular response.Discrepancies between what was intended and what was understood were noted.29 Our working group adapted the tool according to patients’ answers.Consecutive patients were recruited in one university hospital and four general practices in Paris, France.First, we asked 34 consecutive patients to complete the questionnaire.

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