Psychiatric Interviewing and Assessment

Abstract

BOOK REVIEWSW illiam O'Donohue and Eric Levensky remind us in Promoting Treatment Adherence that between 20 and 80 percent of our patients do not complete or continue the treatments we prescribe for them. Reasons for poor adherence can be astounding: one reason cited by the authors is "patients and clinicians often disagree whether a medication has been prescribed." Poor adherence is expensive. Wasted medication prescriptions for elderly patients alone cost more than $1 billion in 2007, to say nothing of the cost in human suffering.The decision to focus on "adherence" rather than "compliance" sets a positive tone for this text. Organized in five sections with different authors for each chapter, the book presents strategies for assessment, which is surprisingly hard to do; improving adherence, with a very nice chapter on the stages of change; adherence to specific treatments, such as exercise or treatments for hypertension or HIV; and working with specific populations, including ethnic minorities and those with cognitive disorders. Most of the information did not strike me as particularly new, but there is much food for thought.As this book notes, it is easier to change oneself than to expect others to change. It's a sad commentary that the more doctors involved in a patient's care, the more likely the patient will be to experience polypharmacy and adverse medication reactions. We can't expect patients to trust that medications are going to work if they frequently don't.