Community-based case managers and peer educators can greatly assist adherence education and adherence strategies in individual patients. Suggestions for strategies for the physicians and health team are noted in Tables 3 and 4 . A trusting relationship is essential. The physician should commit to a feasible mechanism for communication between clinic visits, to ongoing monitoring of adherence, and to substantive responses to adverse events or interim illness. Interim management during physician vacations or other absences must be clarified.
Adherence requires full deployment of the available healthcare team.
Regular reinforcement by two or more team members will assist the goals of adherence. Monitoring may identify periods of poor adherence. Reasonable responses include increasing the intensity of clinical follow up, shortening the follow up interval, and recruiting additional health team members, depending on the nature of the problem. 17 Intermittent drug use or emotional crisis might lead to referral for mental health or chemical dependency assessment or further recruitment an intervention with family or friends. Some patients may require ongoing assistance from support team members from the outset, such as chemically dependent patients, mentally retarded patients in the care of another, children and adolescents, or patients in crisis.