This was one of the best summaries of the issue I have ever read. I would add that pharmaceutical companies are key to solving the problem. I know of a drug used to treat MS, which has adherence rates of 95%, because of the patient support program launched by its manufacturer. Because the drug costs $20,000/year, they can afford to provide "gold standard" assistance, addressing motivation, knowledge, skills, tools, reinforcement, social support, peer support and financial assistance.

If you compare pharma companies to airplance manufacturers - they build great planes, but they have the terrible engines; therefore they never offer enough thrust to get the planes off the ground - and most patients drop off therapy within 100 days. Clearly a better engine is needed. My blog on medication adherence is here: link