title: Reconceptualizing medication adherence: six phases of dynamic adherence.
abstract: Nonadherence is the Achilles' heel of effective psychiatric treatment. It affects the resolution of mental health symptoms and interferes with the assessment of treatment response. The meaning of the term adherence has evolved over time and is now associated with a variety of definitions and measurement methods. The result has been a poorly operationalized and nonstandardized term that is often interpreted differently by providers and patients. Drawing extensively from the literature, this article aims to (1) describe changes in the concept of adherence, drawing from the mental health treatment literature, (2) present a more comprehensive definition of adherence that recognizes the role of patient-provider transactions, (3) introduce dynamic adherence, a six-phase model, which incorporates the role of transactional processes and other factors that influence patients' adherence decisions, and (4) provide recommendations for providers to improve adherence as well as their relationships with patients.
authors.affiliation: Columbia University School of Social Work, New York, NY 10027, USA.
authors.forename: Robin E
authors.initials: RE
authors.lastname: Gearing
authors.forename: Lisa
authors.initials: L
authors.lastname: Townsend
authors.forename: Michael
authors.initials: M
authors.lastname: MacKenzie
authors.forename: Alice
authors.initials: A
authors.lastname: Charach
mesh_terms: D016527:Drug Costs; D005382:Financing, Personal; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D001523:Mental Disorders / Q000188:drug therapy; D008960:Models, Psychological; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010817:Physician-Patient Relations; D011619:Psychotropic Drugs / Q000191:economics / Q000627:therapeutic use; D016312:Treatment Refusal / Q000523:psychology
chemical_list: D011619:Psychotropic Drugs