Telephone counseling to improve osteoporosis treatment adherence: an effectiveness study in community practice settings.

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.