Treatment nonadherence is a recognized problem, but most practice settings use education alone to address it. Psychological counseling methods generate greater behavior change but are not widely used. Telehealth nursing can be used to integrate these methods into routine clinical practice. This study was a nonrandomized trial of a telehealth program that used motivational interviewing and cognitive- behavioral techniques to improve osteoporosis medication adherence. Registered nurses delivered the intervention to 402 participants recruited from provider offices across the United States. Initial participation rates were high in this community-based sample, although attrition also was high. Six-month adherence based on pharmacy and clinical interview data was significantly higher than the general population rate. A comparison with nonparticipants approached significance, and there was a significant dose-response effect. Most reasons given for nonadherence were psychological. The results support the use of psychological techniques to improve adherence and the use of telehealth to disseminate evidence-based patient counseling.

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Antiretroviral therapy remains a challenge for persons living with HIV (PLWH), who must maintain high levels of adherence to prevent viral resistance and treatment failure. This effectiveness study examined a telephonic nursing program to translate well-validated cognitive-behavioral and motivational interviewing adherence counseling into routine clinical care. Participants were 98 PLWH who were followed for up to 6 months after recruitment from HIV care settings across the United States. Each participant received telephone counseling (Mdn =three sessions) from a trained nurse who followed up with the participant over time. Nurses assessed participants' readiness for adherence, provided support to overcome identified barriers, and offered information based on participants' questions. At 6 months after the start of treatment, a greater percentage of participants had adherence at or above 95% than expected for this population, based on a clinical interview. Self-efficacy was related to baseline medication adherence, whereas other clinical and demographic variables were not. Attrition was a concern but was unrelated to adherence, self-efficacy, or clinical severity measures. Telephone counseling was associated with a relatively high percentage of participants reaching target antiretroviral therapy adherence levels and may be an effective method to disseminate psychologically based counseling into a broad range of care settings.