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after discussion and counseling based on the edm data, all subjects and clinicians agreed that the patient was not ready to change. at this point, the next phase in the process was to assist patients in developing specific, written, personalized medication adherence plans based on what the clinicians and patients felt would be most effective for that patient to adhere. the goal was to achieve at least 95% adherence. the adherence plan was reviewed at a subsequent visit. the goal for the second phase was to keep patients on their target medication regimen for the duration of the trial, unless there were compelling clinical indications to discontinue medications. at each intervention visit, a study member discussed the subject's adherence plan, assessed barriers to adherence, and offered the patient the opportunity to prioritize the plan, modify it, or share information about a medication or problem that was interfering with adherence. the investigator offered counseling and problem solving strategies specific to the identified problem. in the event that the subject and clinician felt that a more immediate change was needed, counseling was immediately followed by a change in the subject's prescription. general encouragement and information were provided to help patients stay on their medication plan

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subjects in the control group also met with a study member monthly for a short counseling session that focused on medication adherence using the same techniques and timelines as the intervention group. all subjects in both the intervention and control groups received usual care from the ghc primary care or mental health providers, as deemed appropriate by the providers

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