- Home
- POMA
- POMA Foundation
- DO Voices
- Residents & Students
- Resident Information
- Student Information
- Scholarship Opportunities
- Clinical Writing Contest
- Scientific Poster Session
- Winter Residency Fair
- Education
- Advocacy
- Affiliates
- Public
|
Enhancing Patient Adherence in the All-Too-Brief Office Visit June 2026 | Vol. 70, No. 2 Visits to follow up on medication and chronic disease management can be as short as We like to think of the process of medical care as a fairly linear event in which the doctor gives an order and the patient quietly obeys. But what really happens is usually “messier” than that. Most clinicians would probably agree that the clinician-patient encounter can be quite complex, and what the patient does after it can be influenced by a host of unexpected factors. Decades before they had mountains of data supporting their intuition, many clinicians felt that the hardest part of practicing medicine often wasn't the diagnosis but rather it was the follow-through. It is said that human behavior is the “wildcard” in medical care delivery, and patient nonadherence is a huge and often unmet challenge. On average, one in four patients are "nonadherent" to their physicians’ advice; in the context of some disease conditions, the nonadherence rate is considerably higher. For every four people who walk into a doctor’s office seeking help, one of them will walk out and leave that help behind. Often this happens before the process of care even starts; fifteen percent of prescriptions are never filled. In many chronic conditions, close to 50% of patients have stopped adhering within six months of embarking on their treatment regimens. Nonadherence can remain a secret. Clinicians often make incorrect assumptions about their patients and have difficulty predicting who will be nonadherent. Many patients are embarrassed or afraid to admit resistances or difficulties. Many are inconsistent in their adherence; they might be very adherent to some treatments and not at all to others. It is rare for a patient to say what you wish they would: “I’m having trouble taking the meds you prescribed. Can you help me?” Adherence tends to be easier with simple regimens, especially those that help alleviate symptoms. But even when medication is helpful, consistent maintenance can be difficult. For example, 43-60% of patients with IBD on an oral medication to prevent flare-ups are nonadherent. Treatments that require lifestyle change to reduce potential future risk can be especially challenging. Nonadherence might be unintentional because the patient lacks knowledge, skills, time, and resources necessary to follow treatment. Sometimes nonadherence is intentional -- driven by skepticism of the diagnosis or treatment efficacy, distrust or fear of the medication, competing viewpoints of family, culture, the internet, and social media. The patient might choose nonadherence out of frustration, boredom, or disappointment that cure is out of reach. How might a clinician manage all of these factors? Here is a simple, evidence-based heuristic, developed by my research team, to organize the many unique elements each patient brings to the adherence equation.1 Simply put: patients can do only what they know, understand, and remember; they will follow only treatments they want to follow, and they will do only what they are able to do. Simply put: What does your patient know, what do they want, and what are they able to do? These three questions form the Information-Motivation-Strategy Model and when kept front-of-mind in every conversation with a patient, they can help apply your clinical experience and knowledge of your patient as a person to support their health behavior change and treatment adherence. In this article, you will find numerous suggestions, some of which might be helpful for you to add to your communication repertoire. As you create a unique profile for each patient, you can assess, in the natural course of conversation, your patient’s challenges, strengths, questions, concerns, problems, and potential solutions in each of these three categories. The Information phase is not simply about telling your patient clearly what you want (although clarity is critical, and can be surprisingly hard). It also involves listening carefully to what your patient tells you, and figuring out what they understand and remember. Studies show that between 40 and 80 percent of what patients are told during the medical visit is forgotten (perhaps because of low health literacy or anxiety) by the time they exit the office. What can you do to help them remember? Communicate clearly, print out a visit summary with the most important points, and go over your directives with the patient. Ask them to tell you what they understand, and to commit to the next steps in their care. Or have your patient debrief with another member of the care team. How have they been taking their medication? Have any changes been made? How will they accommodate the changes? What exactly are they planning to do next? Pay attention to, and be ready to discuss, nonadherence “red flags” such as the worsening of a previously well-controlled condition, lags in or missed refills on EMR, and vague answers to inquiries such as, “How do you take your medicine?” Ask, connect, understand, and be nonjudgmental and empathic. “Are you taking your medication?” invites a “yes.” Open up a discussion of concerns: “Sometimes patients find it hard to take their pills every single day. In a typical week, how many doses do you think you might miss?” or “What do you find is the hardest part about following this plan?” Hold open lines of communication for honest interchange. Listen carefully to your patient’s words, and attend to the “language without words” including the sense of rapport and immediacy in your communication with your patient. Give your full attention through vocal tone, eye contact, and facial expressions. Communicate that your patient’s viewpoint is highly valued, and foster trust and engagement. Meta-analytic work shows that effective communication is the foundation of treatment adherence; there is 19% greater adherence among patients of providers with better versus more limited communication skills. What does your patient want to do? This is where Motivation comes in. Patient behavior can be complicated by held beliefs, and by the opinions, fears, and concerns of family and friends and online social networks. Patients rarely follow treatments they don’t believe in, no matter how many diplomas hang on the office wall. It can take discipline for a clinician to stop talking and start asking: What do you believe will happen if you take this medicine? What do you hope for? Is there anything that gives you pause, or that you are afraid of? What have you heard or learned on the internet? Who else matters in this decision? What do they think? Following a treatment can require impressive effort-- which the patient can often muster if they truly believe that the benefits outweigh the risks and costs (in funds, time, effort, and commitment). A collaborative partnership between clinician and patient can help increase the patient’s personal motivation. The endorsement of a trusted clinician can be a strong motivator for adherence—even stronger than the influence of what family, friends, and peers think they should do. Finally, there is the Strategy-- what the patient is actually able to do in the context of their life. At the end of a long day, many patients struggle for enough self-control to manage a complex diet or a new exercise routine. We all need more than just a "will" to be healthy; we need a plan and often really need assistance. Nonadherent patients often have significant resource limitations, including financial strain, family responsibilities and care demands, transportation challenges, work pressures, and even unique features such as fear of needles or difficulty swallowing pills. The more complex the regimen, and/or the more difficult the side effects, the greater the chance of nonadherence. Here, too, it is so important to fully listen to and understand the patient’s point of view; such difficulties are not excuses. Shared with the clinician, they can represent a valuable opportunity to partner and manage together with plans for adjustment and further discussion. Reducing medication burden, prescribing 90-day refills to reduce logistical friction, consolidating doses where possible, and having members of the healthcare team assist patients with adherence strategies (e.g., pairing meds with daily activities, using fill-ahead pill boxes, setting smartphone alerts/medication reminders) can be welcome elements of whole person care. It is important for clinicians to be aware of the ways in which a patient’s experience of depression might contribute to nonadherence. Considerable research shows that 30-50% of individuals with chronic illness have comorbid depression and are three times more likely to be nonadherent to their medical treatment. This is not surprising, because depression is typically characterized by pessimism and hopelessness, cognitive challenges, difficulty planning, and social withdrawal. As part of the visit conversation, the clinician, or another member of the healthcare team, might administer the Patient Health Questionnaire-2 (PHQ-2): a two-item screener for adults to assess depressed mood and anhedonia. Alternatively, the clinician might ask about these feelings in conversation, and plan for further discussion or referral. Social support is critical to adherence; having someone to help in practical and emotionally supportive ways can make the burden of care lighter. Family or friends’ encouragement, supervision, and modeling of health behaviors can improve the odds of adherence. Assistance with chores, reminders, transportation, shopping and cooking heart healthy meals, and at-home injections can increase the odds of adherence almost fourfold. Emotional support offers a substantial boost to adherence, while family conflict can jeopardize adherence significantly. Each office practice or system may have unique ways in which healthcare teams and technologies can further enhance patient adherence, including the use of AI to support all members of the healthcare, offering more time and connection with patients. Healthcare team members can offer valuable support to patients’ physical and mental health, particularly when teams are trained in behavioral management and chronic disease care. Strong evidence supports the integration of mental health expertise in primary care practice, as well as collaboration among multiple providers in care. Every touch point matters; all staff can model and inspire healthy action, awareness, caring, empathy, and encouragement, with patients and within the healthcare team. In conclusion: The Information-Motivation-Strategy Model serves as a simple way to organize communication with your patient about the regimen to which you hope they will adhere. As you view your patient within the provider-patient relationship as well as within the context of their own life, try to understand better who your patient is as a person. What matters to them? What do they believe about their health? How do they live, what are their health habits? What are their resources and limitations? What stresses are on them? Are they depressed, anxious, or discouraged? Can you help them to feel hopeful? Nonadherence is not failure; adherence is a process. It involves two-way doctor-patient communication, collaborative decision making, trust and empathy. Sometimes successful medicine is less about the chemistry of the drug and more about the chemistry of the therapeutic conversation. Footnote: (Note: This article was requested by the undersigned after reviewing the book Health Behavior Change and Treatment Adherence: Evidence-based Guidelines for Improving Healthcare, 2nd edition, Oxford University Press in the February 2026, Vol. 70, No. 1., issue of the JPOMA. In essence, I asked for a short, concise recommendation for the busy physician. I am pleased to present this article written by M. Robin DiMatteo, Ph.D.
|