Interventions Targeting Social and Contextual Factors Beyond the Patient and Family

The clinic's structure, the patient's insurance status, and other social and contextual factors that are beyond a patient's or family's control may also be important. For example, improving the training of residents in a clinic and decreasing copayments for certain medications have both been advocated to improve adherence and disease control (Bernard et al. 1999; Chernew et al. 2008). Interestingly, few interventions that are targeted at the provider and societal levels have been rigorously studied in pediat-ric adherence research (Kahana et al. 2008). We believe that such interventions have great promise. In current practice, providers do not routinely inquire about adherence, do not provide ongoing comprehensive support for adherence promotion, and rarely check with patients concerning their understanding of treatment. Providers seldom anticipate or manage barriers to adherence or provide developmental "updates" or anticipatory guidance for children, adolescents, and families across developmental transitions (Pai and Drotar 2009).

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