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Medicine and Public Policy |

Rethinking Adherence

John F. Steiner, MD, MPH
[+] Article, Author, and Disclosure Information

From the Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.

Disclaimer: The content is solely the responsibility of the author and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

Acknowledgment: The author thanks Michael Chase, MD; Michael Horberg, MD; and Marsha Raebel, PharmD, for their helpful comments on a draft of the manuscript.

Grant Support: By grant R01HS019859 from the Agency for Healthcare Research and Quality.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1075.

Requests for Single Reprints: John F. Steiner, MD, MPH, Institute for Health Research, Kaiser Permanente Colorado, PO Box 378066, Denver, CO 80237-8066; e-mail, john.f.steiner@kp.org.

Author Contributions: Conception and design: J.F. Steiner.

Drafting of the article: J.F. Steiner.

Critical revision of the article for important intellectual content: J.F. Steiner.

Final approval of the article: J.F. Steiner.

Statistical expertise: J.F. Steiner.

Obtaining of funding: J.F. Steiner.

Ann Intern Med. 2012;157(8):580-585. doi:10.7326/0003-4819-157-8-201210160-00013
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In 2012, the Centers for Medicare & Medicaid Services (CMS) will introduce measures of adherence to oral hypoglycemic, antihypertensive, and cholesterol-lowering drugs into its Medicare Advantage quality program. To meet these quality goals, delivery systems will need to develop and disseminate strategies to improve adherence. The design of adherence interventions has too often been guided by the mistaken assumptions that adherence is a single behavior that can be predicted from readily available patient characteristics and that individual clinicians alone can improve adherence at the population level.

Effective interventions require recognition that adherence is a set of interacting behaviors influenced by individual, social, and environmental forces; adherence interventions must be broadly based, rather than targeted to specific population subgroups; and counseling with a trusted clinician needs to be complemented by outreach interventions and removal of structural and organizational barriers. To achieve the adherence goals set by CMS, front-line clinicians, interdisciplinary teams, organizational leaders, and policymakers will need to coordinate efforts in ways that exemplify the underlying principles of health care reform.


Grahic Jump Location

Sociodemographic predictors do not differentiate nonadherent from adherent individuals: an illustration.

Grahic Jump Location




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