National framework for medication adherence in asthma care in North Macedonia: evaluation of policy

Aim: For this aim, a targeted literature review was conducted using scientific databases (PubMed, Scopus, Medline, Google Scholar) to identify studies on adherence measurement in the country. In addition, four key national documents were reviewed in the same context: Good Pharmacy Practice guidelines (2009), National Health Strategy 2021–2030, Guidelines for Evidence-Based Medicine in Asthma Treatment at the Primary Healthcare Level (2023), and Law on Health Care. Methods: A targeted literature review was conducted using scientific databases (PubMed, Scopus, Medline) to identify studies related to adherence measurement in North Macedonia. Additionally, four key national documents were reviewed for content on adherence: Good Pharmacy Practice Guidelines (2009), National Health Strategy 2021–2030, Guidelines for Evidence-Based Medicine in Asthma Treatment at the Primary Healthcare Level (2023), and the Law on Health Care. Results: The findings revealed that adherence is not systematically addressed in any of the documents, except for the guidelines for evidence-based medicine from 2003, which briefly mention that adherence should be monitored using appropriate tools; however, no specific instruments or protocols are defined. There is also a lack of validated tools available in Macedonian language for this purpose. Discussion and conclusion: This evaluation highlights a significant gap in the national policy framework regarding structured approaches to monitoring and improving adherence in asthma care. The integration of adherence assessment into national strategies, supported by clear guidelines and validated tools, is necessary for enhancing clinical practice and improving patient outcomes.