For chronic medical conditions, such as hypercholesterolemia and hypertension, a wide and persistent separation exists between evidence-based recommendations and the actual care patients receive.1 Reasons for this gap are not always clear, but some components are obvious, including failing to identify patients in need of treatment, not properly initiating treatment, failing to provide proper drugs at proper doses, and neglecting to involve the patient in the choices inherent in care. Lack of persistence with adherence to prescribed treatments is a critical part of the gap.2 A sustained high level of adherence identifies a pattern of healthy behaviors3,4 and allows medications shown to be effective in clinical trials to improve outcomes, but this is difficult to achieve with many chronic conditions. For instance, adherence rates to cholesterol-lowering drugs or antihypertension medications are poor.5- 8
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