Welcome to the
Adherence Estimator ®
This survey resource can help you identify patients who may
be at risk for medication nonadherence. The Adherence Estimator has been
validated for oral medications prescribed for certain chronic, asymptomatic
conditions (eg, high cholesterol, diabetes). The Adherence Estimator has not
been validated for symptomatic conditions (eg, asthma). For symptomatic
conditions, even medications that should be taken continuously may be
prescribed or taken on an as-needed basis.
Proceed to the survey
The Adherence Estimator®
New Prescription Survey
Your doctor would like to know your thoughts and opinions about your new medicine. Please answer the following questions.
There are no right or wrong answers.
Medication:
For each question, please touch the box that best describes how you feel about the medicine noted above.
1
Agree Agree Agree Disagree Disagree Disagree
completely mostly somewhat somewhat mostly completely
I am convinced of the importance
of my prescription medicine.
2
Agree Agree Agree Disagree Disagree Disagree
I worry that my prescription completely mostly somewhat somewhat mostly completely
medicine will do more harm
than good to me.
3
Agree Agree Agree Disagree Disagree Disagree
I feel financially burdened completely mostly somewhat somewhat mostly completely
by my out-of-pocket expenses
for my prescription medicine.
submit
Thank You!
Your health care professional will discuss your answers with you.
For the Health Care Professional
The Adherence Estimator®
Interpretation Guide
If a patient falls into the medium or high categories,
you can use the appropriate Response Card to help support your discussion.
! Commitment Patient’s belief that prescription medication is necessary. Total number of points 0
Agree Agree Agree Disagree Disagree Disagree
completely mostly somewhat somewhat mostly completely
High likelihood for
8–36 nonadherence
(<32% probability for adherence)
Low Medium High
? Concern Patient’s concern that prescription medication will do more harm than good. Medium likelihood for
2–7 nonadherence
Agree Agree Agree Disagree Disagree Disagree (32%–75% probability for adherence)
completely mostly somewhat somewhat mostly completely
Low likelihood for
High Medium Low 0 nonadherence
(>75% probability for adherence)
$ Cost Patient’s belief that prescription medication is not affordable.
Agree Agree Agree Disagree Disagree Disagree
completely mostly somewhat somewhat mostly completely
Medium Low Low
Adherence Estimator Kit: Interactive PDF
Copyright © 2016 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. English
Adherence Estimator® is a registered trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Copyright © 2008 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. NOND-1149757-0000 02/16
