Improving patient adherence

Abstract

Compliance or adherence problems are common in diabetes management. Many factors are potentially related to these problems, including demographic, psychological, social, health care provider and medical system, and disease- and treatment-related factors. The terms "compliance" and "adherence" are problematic constructs that may actually serve to perpetuate diabetes management difficulties. Because diabetes is a chronic illness requiring a variety of self-management behaviors, a patient-centered collaborative model of care recognizing patient autonomy provides a more skillful approach to improving diabetes self-care behaviors. To improve patients' diabetes self-management behaviors, health care providers should cultivate patient-centered relationships that respect patient autonomy; organize their clinic or office to be patient-friendly; provide continuity of care with interim telephone contacts; talk collaboratively with patients about treatment rationales and goals; brain-storm and problem-solve with their patients; gradually implement and tailor the regimen; provide written instructions; use self-monitoring, social supports and reinforcement, and behavioral contracts; and routinely refer patients to behavioral health specialists.