title: Diagnosing medication non-adherence in a patient with myocardial infarction.
abstract: BACKGROUND
  Medication non-adherence continues to be a major challenge facing the healthcare system. A case is presented of a 48-year-old man with myocardial infarction who was found to be non-adherent to multiple medications. Conceptual models are reviewed along with current approaches for assessment and treatment of medication non-adherence.
  
  
  METHODS
  Case report and literature review.
  
  
  CONCLUSIONS
  A theoretical model for medication non-adherence built on the Theory of Planned Behavior is presented. Empirical evidence is reviewed for determinants of non-adherent behavior such as health beliefs and self-efficacy. Current methods to assess medication non-adherence, including self-report, pill count, biological drug levels, pharmacy refill, and electronic bottles are summarized along with their limitations. Finally, an individualized approach for assessment is described using the case presented and the conceptual framework outlined above. Follow-up for the patient and potential interventions to improve medication adherence are discussed.
  
  
  CONCLUSIONS
  Despite the challenges, a conceptual framework for medication non-adherence can guide assessment and treatment. Further research for innovative and effective methods to detect and treat medication non-adherence is urgently needed to aid clinicians in treating this pervasive behavioral problem.
authors.affiliation: Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center New York, NY, USA.
authors.forename: Siqin
authors.initials: S
authors.lastname: Ye
authors.forename: David J
authors.initials: DJ
authors.lastname: Krupka
authors.forename: Karina W
authors.initials: KW
authors.lastname: Davidson