Skip to main content
SpringerLink
Log in

Enhancing adherence to long-term medical therapy: A new approach to assessing and treating patients

  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Poor adherence to medical therapy may cause as much as $100 billion in unnecessary healthcare expenses each year. Nonadherence is a complicated and dynamic problem that involves patient, medication, and prescriber factors. The Case Management Adherence Guidelines (CMAG-1) are an evidence-based algorithm that introduces concepts and strategies for assessing medical knowledge and readiness to change (motivational interviewing). Once the assessment has been made, the guidelines can be used regularly to help patients become and remain adherent to their medication regimens. CMAG-1 and its tools, based on up-to-date information about adherence and ways to promote behavioral change, are designed to identify motivational and knowledge deficiencies that may block adherence. As information accumulates from centers that use it, CMAG-1 will be modified accordingly, with the goal of creating structured interaction with patients that will increase their knowledge and motivation to take medication appropriately.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Miller NH, Hill M, Kottke T, Ockene IS, for the Expert Panel on Compliance. The multilevel compliance challenge: recommendations for a call to action.Circulation. 1997;95:1085–1090.

    PubMed  CAS  Google Scholar 

  2. Coons SJ. Medication compliance: the search for answers continues [editorial].Clin Ther. 2001;23:1294–1295.

    Article  PubMed  CAS  Google Scholar 

  3. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review.J Clin Pharm Ther. 2001;26:331–342.

    Article  PubMed  CAS  Google Scholar 

  4. Podell RN, Gary LR. Compliance: a problem in medical management.Am Fam Physician. 1976; 13:74–80.

    PubMed  CAS  Google Scholar 

  5. Zimmerman GL, Olsen CG, Bosworth MF. A ‘stages of change’ approach to helping patients change behavior.Am Fam Physician. 2000:61:1409–1416.

    PubMed  CAS  Google Scholar 

  6. TEC Assessment Program.Special Report. Interventions to Improve Patient Adherence With Medications for Chronic Cardiovascular Disorders. Chicago, Ill: Blue Cross and Blue Shield Association; 2003.

    Google Scholar 

  7. Wilson JF. The crucial link between literacy and health.Ann Intern Med. 2003;139:875–878.

    PubMed  Google Scholar 

  8. Chesney M. Adherence to HAART regimens.AIDS Patient Care STDS. 2003;17:169–177.

    Article  PubMed  Google Scholar 

  9. Coleman VR. Physician behaviour and compliance.J Hypertens Suppl. 1985;3:S69-S71.

    PubMed  CAS  Google Scholar 

  10. Roter DL, Hall JA, Merisca R, Nordstrom B, Cretin D, Svarstad B. Effectiveness of interventions to improve patient compliance: a meta-analysis.Med Care. 1998;36:1138–1161.

    Article  PubMed  CAS  Google Scholar 

  11. Vik SA, Maxwell CJ, Hogan DB. Measurement, correlates, and health outcomes of medication adherence among seniors.Ann Pharmacother. 2004;38:303–312.

    PubMed  Google Scholar 

  12. Adherence to Long-Term Therapies.Evidence for Action. Geneva, Switzerland: World Health Organization; 2003.

  13. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors.Am Psychol. 1992;47:1102–1114.

    Article  PubMed  CAS  Google Scholar 

  14. Morisky DE, Levine DM, Green LW, Shapiro S, Russell RP, Smith CR. Five-year blood pressure control and mortality following health education for hypertensive patients.Am J Public Health. 1983;73:153–162.

    Article  PubMed  CAS  Google Scholar 

  15. Bass PF III, Wilson JF, Griffith CH. A shortened instrument for literacy screening.J Gen Intern Med. 2003;18:1036–1038.

    Article  PubMed  Google Scholar 

  16. Ammassari A, Trotta MP, Murri R, et al. Correlates and predictors of adherence to highly active antiretroviral therapy: overview of published literature.J Acquir Immune Defic Syndr. 2002; 31 (suppl 3):S123-S127.

    PubMed  Google Scholar 

  17. Broadhead WE, Gehlbach SH, de Gruy FV, Kaplan BH. The Duke-UNC Functional Social Support Questionnaire: measurement of social support in family medicine patients.Med Care. 1988;26:709–723.

    Article  PubMed  CAS  Google Scholar 

  18. Miller RH, Rollnick S.Motivational Interviewing: Preparing People for Change. 2nd ed. New York, NY: Guilford Press; 2002.

    Google Scholar 

  19. Stewart RB, Caranasos GJ. Medication compliance in the elderly.Med Clin North Am. 1989;73: 1551–1563.

    PubMed  CAS  Google Scholar 

  20. Cline CMJ, Björck-Linné AK, Israelsson BYA, Willenheimer RB, Erhardt LR. Non-compliance and knowledge of prescribed medication in elderly patients with heart failure.Eur J Heart Fail. 1999;1:145–149.

    Article  PubMed  CAS  Google Scholar 

  21. Barat I, Andreasen F, Damsgaard EMS. Drug therapy in the elderly: what doctors believe and patients actually do.Br J Clin Pharmacol. 2001;51:615–622.

    Article  PubMed  CAS  Google Scholar 

  22. Wood W, Gray J. An integrative review of patient medication compliance from 1990–1998.Online J Knowl Synthesis Nurs. 2000;7:1–11.

    Google Scholar 

  23. Drug Therapy Considerations in Older Adults; VII. Sacramento, Calif: California State Board of Pharmacy; 2003.

  24. Divertie V. Strategies to promote medication adherence in children with asthma. MCNAm J Matern Child Nurs. 2002;27:10–18.

    Article  PubMed  Google Scholar 

  25. Hoffman RP. Adolescent adherence in type 1 diabetes.Compr Ther. 2002;28:128–133.

    Article  PubMed  Google Scholar 

  26. Steele RG, Grauer D. Adherence to antiretroviral therapy for pediatric HIV infection: review of the literature and recommendations for research.Clin Child Fam Psychol Rev. 2003;6:17–30.

    Article  PubMed  Google Scholar 

  27. Tebbi CK. Treatment compliance in childhood and adolescence.Cancer. 1993;71:3441–3449.

    Article  PubMed  CAS  Google Scholar 

  28. Zilberman ML, Tavares H, Blume SB, el-Guebaly N. Substance use disorders: sex differences and psychiatric comorbidities.Can J Psychiatry. 2003;48:5–13.

    PubMed  Google Scholar 

  29. Kushel MB, Vittinghoff E, Haas JS. Factors associated with the health care utilization of homeless persons.JAMA. 2001;285:200–206.

    Article  PubMed  CAS  Google Scholar 

  30. Neff JA, Zule WA. Predictive validity of a measure of treatment readiness for out-of-treatment drug users: enhancing prediction beyond demographic and drug history variables.Am J Drug Alcohol Abuse. 2002;28:147–169.

    Article  PubMed  Google Scholar 

  31. Carter S, Taylor D, Levenson R.A Question of Choice—Compliance in Medicine Taking. A Preliminary Review. London, England: University of London School of Pharmacy; 2004.

    Google Scholar 

  32. Charles H, Good CB, Hanusa BH, Chang C-C-H, Whittle J. Racial differences in adherence to cardiac medications.J Natl Med Assoc. 2003;95:17–27.

    PubMed  Google Scholar 

  33. Lucas GM, Cheever LW, Chaisson RE, Moore RD. Detrimental effects of continued illicit drug use on the treatment of HIV-1 infection.J Acquir Immune Defic Syndr. 2001;27:251–259.

    PubMed  CAS  Google Scholar 

  34. Opolka JL, Rascati KL, Brown CM, Gibson PJ. Role of ethnicity in predicting antipsychotic medication adherence.Ann Pharmacother. 2003;37:625–630.

    Article  PubMed  Google Scholar 

  35. de Groot M, Welch G, Buckland GT 3rd, Fergus M, Ruggiero L, Chipki SR. Cultural orientation and diabetes self-care in low-income African Americans with type 2 diabetes mellitus.Ethn Dis. 2003;13:6–14.

    PubMed  Google Scholar 

  36. Kalichman SC, Catz S, Ramachandran B. Barriers to HIV/AIDS treatment and treatment adherence among African-American adults with disadvantaged education.J Natl Med Assoc. 1999; 91:439–446.

    PubMed  CAS  Google Scholar 

  37. Collins KS, Tenney K, Hughes DL. Quality of health care for African Americans. Findings from the Commonwealth Fund 2001 Health Care Quality Survey. Available at: http://www.cmwf.org/ programs/minority/collins_africanamerican_fs_524.pdf. Accessed on August 20, 2004.

  38. Auslander WF, Thompson S, Dreitzer D, White NH, Santiago JV. Disparity in glycemic control and adherence between African-American and Caucasian youths with diabetes. Family and community contexts.Diabetes Care. 1997;20:1569–1575.

    Article  PubMed  CAS  Google Scholar 

  39. Francis CK. Hypertension, cardiac disease, and compliance in minority patients.Am J Med. 1991; 91(suppl 1A):29S-36S.

    Article  PubMed  CAS  Google Scholar 

  40. Risser AL, Mazur LJ. Use of folk remedies in a Hispanic population.Arch Pediatr Adolesc Med. 1995;149:978–981.

    PubMed  CAS  Google Scholar 

  41. Murphy DA, Roberts KJ, Hoffman D, Molina A, Lu MC. Barriers and successful strategies to antiretroviral adherence among HIV-infected monolingual Spanish-speaking patients.AIDS Care. 2003;15:217–230.

    Article  PubMed  CAS  Google Scholar 

  42. Lasater L, Mehler PS. The illiterate patient: screening and management.Hosp Pract. 1998;33: 163–165, 169–170.

    CAS  Google Scholar 

  43. Nichols-English G, Poirier S. Optimizing adherence to pharmaceutical care plans.J Am Pharm Assoc. 2000;40:475–485.

    CAS  Google Scholar 

  44. Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection.Ann Intern Med. 2000;133:21–30.

    PubMed  CAS  Google Scholar 

  45. Golin CE, Liu H, Hays RD, et al. A prospective study of predictors of adherence to combination antiretroviral medication.J Gen Intern Med. 2002;17:756–765.

    Article  PubMed  Google Scholar 

  46. Nosé M, Barbui C, Tansella M. How often do patients with psychosis fail to adhere to treatment programmes? A systematic review.Psychol Med. 2003;33:1149–1160.

    Article  PubMed  Google Scholar 

  47. Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C. Patient adherence in the treatment of depression.Br J Psychiatry. 2002;180:104–109.

    Article  PubMed  CAS  Google Scholar 

  48. Cheever LW. Adherence to HIV therapies. Available at: http://hab.hrsa.gov/publications/ chapter5/chapter5.htm. Accessed on August 20, 2004.

Download references

Author information

Authors and Affiliations

  1. S.A. Squared, Inc., 19912 Rothert Lane, 92646, Huntington Beach, CA

    Sherry L. Aliotta RN, BSN, CCM (President and CEO)

  2. Pfizer, Inc., New York, New York

    Jon J. Vlasnik PharmD, BCPS & Bonnie DeLor PharmD, BCPS

Authors
  1. Sherry L. Aliotta RN, BSN, CCM
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jon J. Vlasnik PharmD, BCPS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bonnie DeLor PharmD, BCPS
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aliotta, S.L., Vlasnik, J.J. & DeLor, B. Enhancing adherence to long-term medical therapy: A new approach to assessing and treating patients. Adv Therapy 21, 214–231 (2004). https://doi.org/10.1007/BF02850154

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02850154

Keywords

Search

Navigation