Improving Adherence-Sharing Experiences Jill S Burkiewicz and Kathy E Fit Nonadherence is a significant concern for practitioners. Adherence rates have been estimated at 50%, demonstrating the need for information regarding interventions to improve adherence. Patient education through creative analogies or stories mayhelpovercome barriers related to patient misconceptions. There is a needfor individual clinicians to havea forum for sharing successful strategies used In patient adherence on an individual level. An electronic column for clinicians to share Innovative approaches mayfillthis need. KEY WORDS: adherence, compliance, drug therapy, patient attitudes, patient counseling, patient education, persistence. Ann Pharmacother 2007;41 :2058-60. Published Online, 23 OCt 2007, www.theannals.com.DOI10.1345/aph.1 K350 A n 82-year-old woman comes intothe clinic for a follow-up visit. Her blood pressure today is 174/96 mm Hg. Her medications for hypertension include val- sartan 320 mg daily, recently increased from 160 mg daily because her blood pressure was not at goal at her last visit. Upon discussion, the patient states thatshe has not been taking valsartan because it is "too strong." Shecitesthat her old blood pressure medicine was"only20 mg." At a follow-up clinic visit,a 63-year- old man withdiabetes has a random fin- gerstick glucose measurement of 186mg/dL. His recent fast- ing laboratory test results revealed blood glucose 148mg/dL and hemoglobin Ale 7.4%.The clinician discovers thatthe patienthas not started taking metformin, which was pre- scribed 3 months ago.The patient states thathe did notstart the medication "because I don't feel like I have diabetes." Pharmacists encounter similar patients in their daily practice, and manymay struggle to find effective strategies to address nonadherence. In The Annals in 2005, Van Wijk et al.' acknowledged the needfor further studies evaluating successful adherence-improving strategies. We applaud the call for evidence-based information regarding interven- tions to improve adherence. However, the value of sharing effective individualized patient-care strategies should not be overlooked. Evidence-based medicine not only takes into accountthe best available literature but also incorpo- rates clinician experiences and patient preferences, values, and expectations.' These elements combine to create a therapeutic alliance that optimizes patient quality of life and clinical outcomes. Involving the patient is essential. After all, prescribing, recommending, or dispensing a medication will have little effecton the desired outcomes if Author information provided attheendofthe text. the patient is not motivated to take the drug or to take it in the appropriate manner. In 2004, The Annals calledfor a changein terminology froin"compliance" to "adherence,'? This change embraces the ideathata partnership between the patient and provider is needed to better address the patient's needs. The term moves away from a suggestion of the patient as a sub- servientplayer in the healthcare system who yields to the instructions of the paternalistic healthcare provider. This change in terminology is an important step in encouraging providers to share responsibility for nonadherence with the patient. Partnering withthe patient to optimize both the un- derstanding of instructions and "buy-in" to therapy is as essential as the specific therapeutic choice for the preven- tionor treatment of disease. Models that addresschange in health behavior, includ- ing the Health BeliefModel and the Transtheoretical Mod- el of Health Behavior Change, discuss the role of patients' beliefs and attitudes." The HealthBeliefModelproposes that patients will alter their health behaviors if they believe that theyare susceptible to the condition, the consequences are severe,the treatment wouldbe beneficial, and the ben- efits of the treatment outweigh the risks.' Clinicians can target these different beliefs in order to alter patients' health behaviors, including medication adherence. The 2058 • The Annals of Pharmacotherapy • 2007December, Volume 4J wwwtheannals com