Novel delivery vehicles, including computerized decision tools, electronic monitoring and feedback, electronic pill cap reminder devices, SMS, and telemonitoring have been studied with promising but mixed results, leading to questions about whether these delivery vehicles are suitable for all patients, and whether they indeed lead to long-term improvements in adherence.4

Financial incentives may be effective as a strategy to improve adherence. A meta-analysis of 15 studies concluded that “financial reinforcement interventions hold potential for improving medication adherence and may lead to benefits for both patients and society.”15 However, this approach raises some ethical concerns, including “dilemmas around fairness and potential coercion,” the “value of medication, source of funding, and how patients would use the money.”16 Further studies are under way to investigate these issues.

Medication monitoring/environmental supports (e.g., Cognitive Adaptation Training, assertive community treatment) are especially important for patients who lack routines or have cognitive deficits.8

Multidisciplinary collaboration between primary care providers, psychiatrists, pharmacists, social workers, and others involved in the patient’s care facilitates addressing the clinical, social, practical, financial, and logistical barriers to adherence.


The authors encourage a “strong alliance between patient and psychiatrist” that enables patients to develop an “accurate model of their illness and treatment.”4 Clinicians should remember that “medication is not the sole focus of a mental health intervention”9 and must be only one component of a larger, holistic approach.


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