FAC T SHEET FOR PROVIDERS

A Health Campaign of Uniformed Services University, www.usuhs.edu, and theCenter for the Study of Traumatic Stress, Bethesda, Maryland, www.CSTSonline.org

Adherence: Addressing a Range ofPatient Health Behaviors
obstacles and sensitivity to the challenges
Patient adherence challenges healthPatient adherence challengesof the prescribed treatment andcare providers and our healthcare system.
recommendations.
Adherence encompasses a wide range
health care providers and ourTaken in a broader perspective,of health behaviors related to routine
healthcare system.
adherence applies to recommendations
preventative healthcare (e.g., annualand treatments during widespreadmammogram, annual physical, andevents (e.g., exposure to public healthcholesterol check), recommendations (e.g.,epidemics, disasters, terrorism, and war). Adherence,
maintaining appropriate weight and smoking cessation),
during these times, is required for accepting and following
and on-going health maintenance (e.g., blood sugarinterventions in order to protect one’s health. Thesechecks, diabetic foot care, and taking medications forinclude behaviors such as taking medications, willingness
depression).
New medical advances (e.g. oral medications forto shelter-in-place, or the need to evacuate one’s home orcommunity after exposure to weapons of mass destruction
cancer treatment) have improved the trajectory of(e.g., anthrax).
many illnesses. The patient’s ability to understand,This Courage to Care Fact Sheet addresses a broadened
tolerate, and appropriately follow prescribed regimens
approach to adherence. We identify “teachable moments”
influences the outcome of treatment. In pediatric andwhen healthcare providers can educate patients aboutelderly populations, physician communication is an
this important health behavior and its implications forimportant factor for patients’ adherence. Equally asindividual, family, and community health.
important is the doctor’s role in anticipating potential
Patient Health Behaviors: Discrete and Continuing
Patient adherence involves two types of health behaviors:
discrete behavior and continuing behavior. Having a
mammogram involves a discrete behavior that should occur
every year or two. Taking a flu shot during flu season isanother example of a discrete behavior. Managing diabetes,on the other hand, requires a complex set of continuing
behaviors for the diabetic and also for their family.
Medical treatments involving discrete behaviors may beeasier for patients to follow as they are less likely to disrupt
one’s lifestyle and can be scheduled to accommodate workor social routines. Medical treatments involving continuing
behaviors, on the other hand, often shape one’s routine andinvolve acceptance and commitment.
Discussion around these issues may help providers andpatients communicate more effectively about healthcare

options in which adherence is an integral part of a desired
outcome (see Table 1).
Strategies to Improve Adherence
Know Your Patient■ Assess their level of understanding their illness andprovide information at that level.

■ Explain treatment benefits and potential adverse effects.
■ Respect a patient’s autonomy, individual rights, andreadiness for change.

Simplify the Treatment or Intervention■ Customize the treatment/recommendation to a patient’s

lifestyle needs.

Continued

■ Seek to reduce frequency of dosing and number of

medications when possible.

■ Facilitate access (e.g., timing of refills, locations ofavailable pharmacies, and mail-in options).

Educate Patients
A routine office visit can become a “teachable moment”
for patient adherence.
■ Recognize and reinforce positive heath behaviors.
■ Commend patients for discrete behaviors like getting a

Anticipate Obstacles■ Address patient concerns, especially fear and stigma,

which can impede their willingness to start or stay witha treatment.

Patient Adherence Challenges Health Care Providers andOur Healthcare System■ Identify approaches (e.g., pill organizers) to helppatients overcome forgetfulness, mismanagement, orlack of motivation.

■ Explain that “feeling better” is not a reason todiscontinue treatment, but a sign that treatment isworking.

Motivate Patients

flu shot or mammogram, and for continuing behaviors
like cessation of smoking, following a diet for weight
loss, lowering of cholesterol, or management of chronic
conditions like diabetes.

■ Tell patients that their “adherence” to these healthsustaining behaviors is valuable to themselves, theirfamilies, and our healthcare system.

Communication to Facilitate Adherence
Adherence may be improved by emphasizing to thepatient:
1. When and how often to take the medicine.
2. The expected time interval before beneficial effects oftreatment may be noticed.

■ Provide relevant examples of improvements resulting

3. The necessity to take medication even after feeling
better.

■ Offer available office/clinic resources to monitor their

4. The need to consult with the physician before
discontinuing medication.

from patient adherence.
treatment regimen.

■ Communicate support and willingness to answer

5. Steps to take if problems or questions arise.

questions after the visit.

Table 1: Discrete and Continuous Health BehaviorsDISCRETE HEALTH BEHAVIORSCONTINUOUS HEALTH BEHAVIORSTime specific/often time limited

Ongoing and complex

Well described

Requires learning and adapting

OperationalOften involves family/employer support/commitment

Doable		Need to monitor, change, collaborate with healthcare
providerCenter for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org