Improving Medication Adherence: Challenges for Physicians, Payers, and Policy Makers
Patrick J. O’Connor.
Arch Intern Med. 2006;166:1802-1804.




In his thought-provoking editorial, Dr. O’Connor succinctly summarizes the problems of noncompliance:

The Challenges

The majority of the paper consists of eight challenges:

CHALLENGE 1: Can we stop blaming patients for medication nonadherence?

CHALLENGE 2: Can we develop office systems or teams that provide necessary information on new medications at the time of prescription?

CHALLENGE 3: Can we develop communication and coordination systems to reduce medication errors at transitions in care?

CHALLENGE 4: Can we use more combination tablets and inexpensive “polypills” to achieve better medication adherence and lower costs?

CHALLENGE 5: Can we promote the use of especially beneficial drugs and reduce the use of less beneficial drugs?

CHALLENGE 6: Can we educate our patients to be nonadherent in a rational way?

CHALLENGE 7: Can anything good come out of drug formularies?

CHALLENGE 8: Can we resist the temptation to medicalize life from birth to death?

Commentary

Implicit in the range of issues encompassed by O’Connor’s eight challenges is the principle that has become my central theme: significant improvement in patient compliance is possible only when the interests of all the stakeholders, including patients, clinicians, and policy-makers are aligned. I’m especially supportive of the notion that patient noncompliance should be considered a potentially valid choice rather than automatically designated healthcare’s cardinal sin. I also admire O’Connor’s endorsement of financial incentives, one of the few compliance enhancements that has been demonstrated to be effective in multiple settings with different patient populations.

While the eight challenges are not of equal significance and do not exhaust the potential issues of adherence to treatment, they do represent the most comprehensive and, more importantly, most potentially useful battle plan for improving adherence that I’ve found. This editorial is an essential read for anyone interested in patient compliance with treatment.

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