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©2013 UpToDate ® Print Email Strategies to improve adherence: patient and medication-related Inform patient regarding side effects. Anticipate and treat side effects. Simplify food requirements. Avoid adverse drug interactions. If possible, reduce dose frequency and number of pills. Negotiate a treatment plan that the patient understands and to whichhe/she commits. Spend time and multiple encounters to educate and explain goals oftherapy and need for adherence. Establish readiness to take medication before writing firstprescription. Recruit family and friends to support the treatment plan. Develop concrete plan for specific regimen by considering mealsschedule, daily routines, and side effects. Provide written schedule and pictures of medications, daily or weeklypillboxes, alarm clocks, pagers, or other mechanical aids for adherence. Develop adherence support groups or add adherence concerns to agenda ofother support groups. Develop link with local community-based organizations regardingadherence combined with educational sessions and practical strategies. Consider practice sessions using candy instead of pills. file://aidsinfo.nih.gov. Strategies to improve adherence: clinician and health team-related Establish trust. Serve as educator and information source with ongoing support andmonitoring. Provide access between visits for questions or problems (eg, byproviding a pager number), including during vacations or conferences. Monitor ongoing adherence; intensify management during periods ofsuboptimal adherence (ie, more frequent visits, recruitment of familyor friends,deployment of other team members, and referral for mental health orchemical-dependency services). Use health team for all patients, including patients with special needs(eg, use peer educators for adolescents or for injection-drug users). Consider impact of new diagnoses on adherence (eg, depression, liverdisease, wasting, or recurrent chemical dependency) and includeadherence intervention in management. Use nurses, pharmacists, peer educators, volunteers, case managers,drug counselors, clinician's assistants, nurse practitioners, andresearch nurses to reinforce adherence messages. Provide training to support team regarding antiretroviral therapy andadherence. Add adherence interventions to job descriptions of support teammembers; add continuity-of-care role to improve patient access. file://aidsinfo.nih.gov. Interventions to improve adherence

Use nurses, pharmacists, peer educators, volunteers, case managers,drug counselors, clinician's assistants, nurse practitioners, andresearch nurses to reinforce adherence messages. Provide training to support team regarding antiretroviral therapy andadherence. Add adherence interventions to job descriptions of support teammembers; add continuity-of-care role to improve patient access. file://aidsinfo.nih.gov. Interventions to improve adherence Pharmacist-based adherence encounters and clinics Multidisciplinary adherence encounters at each visit Reminders, alarms, pagers, or timers on pillboxes Patient education aids, including regimen pictures, calendars, orstickers Clinician education aids (eg, medication guides, pictures, or calendars) file://aidsinfo.nih.gov.

©2013 UpToDate ® Print Email Strategies to improve adherence: patient and medication-related Inform patient regarding side effects. Anticipate and treat side effects. Simplify food requirements. Avoid adverse drug interactions. If possible, reduce dose frequency and number of pills. Negotiate a treatment plan that the patient understands and to whichhe/she commits. Spend time and multiple encounters to educate and explain goals oftherapy and need for adherence. Establish readiness to take medication before writing firstprescription. Recruit family and friends to support the treatment plan. Develop concrete plan for specific regimen by considering mealsschedule, daily routines, and side effects. Provide written schedule and pictures of medications, daily or weeklypillboxes, alarm clocks, pagers, or other mechanical aids for adherence. Develop adherence support groups or add adherence concerns to agenda ofother support groups. Develop link with local community-based organizations regardingadherence combined with educational sessions and practical strategies. Consider practice sessions using candy instead of pills. file://aidsinfo.nih.gov.