20:T471,Low adherence to prescribed medical regimens is a ubiquitous problem. Typical adherence rates are about 50% for medications and are much lower for lifestyle prescriptions and other more behaviorally demanding regimens. In addition, many patients with medical problems do not seek care or drop out of care prematurely. Although accurate measures of low adherence are lacking for many regimens, simple measures, such as directly asking patients and watching for appointment nonattendance and treatment nonresponse, will detect most problems. For short-term regimens (< or =2 weeks), adherence to medications is readily achieved by giving clear instructions. On the other hand, improving adherence to long-term regimens requires combinations of information about the regimen, counseling about the importance of adherence and how to organize medication taking, reminders about appointments and adherence, rewards and recognition for the patient's efforts to follow the regimen, and enlisting social support from family and friends. Successful interventions for long-term regimens are all labor-intensive but ultimately can be cost-effective.21:T449,

CLINICAL SCENARIOS

Case 1

A 28-year-old woman presents to the emergency department in acute distress with a 3-day history of worsening asthma. Her prescribed medications include an inhaled β₂-agonist and an inhaled steroid. When questioned, she breathlessly admits to "occasionally" missing her medications but indicates that this is "maybe only once or twice."

Case 2

A 55-year-old man with posttraumatic seizure disorder has been taking phenytoin since his injury. His seizures were initially adequately controlled but he recently has been having weekly seizures. In an office visit he resentfully denies missing any of his medication.

THE IMPORTANCE OF CLINICAL EXAMINATION

Physicians should measure compliance for patients prescribed a self-administered treatment because noncompliance is common and physicians can help patients to improve their compliance^1,2and increase the benefit they derive from therapy. Compliance with long-term self-administered medication therapy is approximately 50% for those who remain in care.³

	Year	Citations

Abstract

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