Improving Adherence: Who's Doing the Work?

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  • Approximately 50% of patients with chronic illnesses are not adherent to indicated medications, treatment regimens, and healthy lifestyle changes, which can lead to increased morbidity, excess mortality, and tremendous cost.
  • Nonadherence is a challenging problem for clinicians because of the myriad barriers that may contribute and the many complexities of human behavior involved.
  • Barriers to adherence can be patient-related, physician-related, and system- or health team-related.
  • Physicians should be aware that adherence in one behavioral realm does not mean that a patient is adherent to other aspects of a treatment regimen.
  • Motivational interviewing is a one approach to improve adherence in individuals struggling with behavior change.
  • Reflective statements can be used to emphasize content, emotion, both sides of the discrepancy, or an alternative way to frame what the patient has said.
  • Behavioral research demonstrates that patient motivation is a dynamic state that is influenced by the interviewer's style.