Improving Adherence: Who\u27s Doing the Work?

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\u27s style