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The quality of the doctor-patient relationship is one of the most important health care system-related factors impacting adherence (Krueger et al., 2005). A good relationship between the patient and health care provider, which features encouragement and reinforcement from the provider, has a positive impact on adherence (Krueger et al., 2003). Poor provider communication concerning the benefits, instructions for use, and side effects of medications can also contribute to nonadherence, especially in older adults with memory problems (Vermiere et al., 2001).

More broadly, health care systems create barriers to adherence by limiting access to health care in the following ways: making appointments difficult to schedule; lacking continuity of provider care; using restrictive formularies and changing formularies; and through high drug costs, copayments, or both (Osterberg and Blaschke, 2005; Tabor and Lopez, 2004).

Provider-patient relationship

Source: Krueger et al., 2005
Establish a positive, supportive, trusting relationship with the patient
Involve the patient in the decision-making process
Assess the patient's understanding of the illness and treatment
Clearly communicate the benefits of treatment
Involve the patient in setting treatment goals
Assess the patient's readiness to carry out the treatment plan
Identify and discuss any barriers or obstacles to adherence the patient may have and formulate strategies for overcoming them with the patient
Tailor medication regimens to the patient's daily routine
Reduce complexity of medication regimen
Provide appropriate follow-up care
Reward adherence and good or improving performance
Involve family members for social support
Provider communication

Source: Gottleib, 2000
Adopt a friendly rather than a business-like attitude
Spend some time conversing about nonmedical topics
Avoid medical jargon
Use short words and short sentences
Give clear instructions on the exact treatment regimen, preferably in writing
Repeat instructions
Make advice as specific and detailed as possible
Ask the patient to repeat what has to be done