When Ms. Landers, a 30 year old HIV positive patient, comes to my office and is failing on her HAART (Highly Active Antiretroviral Therapy), I wonder why.
Is it because the medicines are not working and resistance has developed? Is it because there is drug-drug interaction with her medicines?
I explore a bit more, “In the past week – how many time do you think you may have missed taking the medicines.”
She is quiet, “A few”
I try to quantitate, because here in lies the diagnosis – “once or twice in a week, or may be five or six times in a week?”
She favors the later, and I know the reason for her failure: lack of adherence. This is one of the most important reasons why patients fail AIDS treatment as well as heart failure and diabetes treatment.
In his motivational booklet, “Sticking to It: The Art of Adherence” Lee J. Colan describes adherence in a math formula:
Adherence = Focus x Competence x Passion
Adherence means sticking to it. It may be a new diet, an exercise plan or a New Year’s resolution. Focus means keeping the goal in mind and making it a priority. Competence is having the skills and knowledge to accomplish the goal. Passion is to have the energy and motivation to drive towards the goal.
So for the entire 20 minute visit, I sit with Ms. Landers and talk about adherence, focus, competence and passion because her survival depends on the HAART medicines.
Adherence is important not just for our health but for the rest of life, especially when 70% of New Year’s resolution last less than a month.