TABLE 2.

Patient barriers to adherence and available solutions

BARRIER	SOLUTION	SPECIFIC STRATEGY
		LOW ACTIVATION (PAM 1 and PAM 2)	HIGH ACTIVATION (PAM 3 and PAM 4)
Treatment complexity and/or forgetfulness	Medication review	Reduce dosing frequency Switch to combination Stop unnecessary medications	Reduce dosing frequency Switch to combination Stop unnecessary medications
	Pill organization and reminders	Pill box reminder Use of apps/alarms Mail order service	Pill box reminder
	Counseling	Counsel about disease/medications as needed	Counsel about disease/medications as needed
	Text messaging	Reminder text messages (weekly or daily)	Reminder text messages (weekly)
	Family and/or social work involvement	Family member support Social work referral	None
Health perception	Counseling	Counsel as needed	Counsel as needed
	Text messaging	Motivational text messages (daily or weekly)	Motivational texts (weekly)
Cognitive impairment	Family and/or social work involvement	Family member support Social work referral	Family member support Social work referral
	Counseling, education	Counsel using simplified teach-back method	Counsel using simplified teach-back method
Lack of knowledge and/or poor health literacy	Counseling	Counsel about disease/medications using teach-back method	Counsel about disease/medications using teach-back method
	Family and/or social work involvement	Family member support Social work referral	None
Experiencing side effects	Medication review	Switch to alternative, adjust dose, or stop Other strategies to reduce side effects Refer to PCP if needed	Switch to alternative, adjust dose, or stop Other strategies to reduce side effects Refer to PCP if needed
	Counseling	Counsel about expected side effects Plan for contact if side effects persist	Counsel about expected side effects Plan for contact if side effects persist
Costs	Medication review	Switch to less expensive option/generic Switch to combination medication Stop unnecessary meds	Switch to less expensive option/generic Switch to combination medication Stop unnecessary meds
	Mail order, social work support	Use of mail order service Social work referral Refer Medicare patients to co-pay assistance program	Use of mail order service Refer Medicare patients to co-pay assistance program
	Counseling	Counsel about disease/medications as needed	Counsel about disease/medications as needed
All barriers	Follow-up calls	All patients receive follow-up calls	Follow-up calls only if clinically indicated

PAM = Patient Activation Measure; PCP = Primary Care Physician