Improving Adherence: Who's Doing the Work?

<p> <ul> <li> 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. </li> <li> Nonadherence is a challenging problem for clinicians because of the myriad barriers that may contribute and the many complexities of human behavior involved. </li> <li> Barriers to adherence can be patient-related, physician-related, and system- or health team-related. </li> <li> 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. </li> <li> Motivational interviewing is a one approach to improve adherence in individuals struggling with behavior change. </li> <li> 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. </li> <li> Behavioral research demonstrates that patient motivation is a dynamic state that is influenced by the interviewer's style. </li> </ul></p>