How to Set Achievable Adherence Goals and Track Progress for Medication Compliance

Getting patients to take their meds as prescribed isn’t just about reminders-it’s about building habits that stick. For people managing diabetes, high blood pressure, or heart failure, missing doses isn’t a small mistake. It’s a risk to their health, their quality of life, and even their longevity. Yet, studies show nearly half of patients with chronic conditions don’t take their medications correctly. The problem isn’t laziness. It’s confusion, complexity, and lack of clear progress. The solution? SMART goals-simple, structured, and backed by real data.

Why SMART Goals Work for Medication Adherence

SMART isn’t just a buzzword. It’s a framework developed in the 1980s for business, but now used in clinics across North America to turn vague advice like “take your pill daily” into something patients can actually follow. A 2023 study from Vozo Health found that patients using structured SMART goals improved adherence by up to 35%. That’s not minor. That’s the difference between staying out of the hospital and needing emergency care.

Here’s what makes SMART different from regular reminders:

• Specific: Instead of “take your blood pressure med,” it’s “Take 10 mg of lisinopril every morning after brushing my teeth.”
• Measurable: You track it. Not just “did I take it?” but “how many days in a row did I take it?”
• Achievable: If someone works two jobs and forgets meals, setting a goal to take five pills at 7 a.m. won’t work. The goal must fit their life.
• Relevant: The goal connects to something they care about-like playing with their grandkids without getting winded.
• Time-bound: “This week, I’ll take my pill every day.” Not “sometime soon.”

Start with the Barriers First (B-SMART)

Many people fail before they even begin because no one asked: What’s stopping you? That’s where B-SMART comes in. It adds one critical step before the SMART structure: identify barriers.

Think about it:

• Can they afford the medication?
• Do they have trouble opening pill bottles?
• Do they forget because they don’t have a routine?
• Are they scared of side effects?
• Do they live alone and no one reminds them?

A 2021 ThoroughCare study showed patients who talked through barriers with their provider were 47% more likely to stick to their goals. For example, if someone says, “I can’t afford my insulin,” the goal isn’t “take insulin daily.” It’s “Call pharmacy on Tuesday to ask about patient assistance programs.” That’s a real, doable step.

How to Track Progress-Without Overwhelming Patients

Tracking doesn’t mean logging every pill in an app. That’s where people quit. The best tracking is simple, visual, and tied to real outcomes.

Here’s what works:

• Smart pill bottles: These beep if not opened at the right time and send data to the provider. Accuracy? 98%.
• Pharmacy refill records: If someone hasn’t refilled their blood thinner in 60 days, that’s a red flag.
• Simple paper charts: A calendar with a sticker for each day they take their med. Patients over 65 prefer this-52% ditch apps after 30 days, according to PMC 8949687.
• Wearable sync: If they use a Fitbit or Apple Watch, link the goal to movement. “Take your heart med and walk 10 minutes.”

A physical therapist in Texas shared on Reddit that using a digital dashboard cut their documentation time by 22 minutes per patient. That’s time they could spend listening, not typing.

Real Examples That Actually Worked

Let’s say you’re helping someone with type 2 diabetes.

Bad goal: “Eat healthier.”

Good SMART goal: “For the next 14 days, I will eat one serving of vegetables with dinner and check my blood sugar before bed every night.”

Now, track it. Use a printed checklist. Every morning, they mark an X. At the end of two weeks, they see: “I did it 10 out of 14 days.” That’s progress. Not perfection.

Another example: A 72-year-old woman with hypertension struggled to remember her pills. Her goal: “Take my amlodipine at 8 a.m., right after I drink my coffee.” She put a sticky note on her coffee maker. She missed two days in the first month. Instead of scolding her, her nurse asked, “What happened those two days?” She said, “I was at my daughter’s. I didn’t bring my coffee mug.” So they switched the cue to “after I brush my teeth.” Result? 28 straight days of adherence.

Tools That Help-And Which Ones to Avoid

There are dozens of apps. Most fail. Why? They’re too complicated. Or they don’t connect to the patient’s real life.

Here’s what’s actually useful:

Comparison of Adherence Tracking Tools

Tool	Best For	Accuracy	Ease of Use	Cost
Smart pill bottles (e.g., Hero, AdhereTech)	Patients with complex regimens	98%	Medium	Often covered by insurance
Pharmacy refill data	Clinics with EHR access	85%	High	Free
Medisafe app	Tech-savvy users under 65	80%	High	Free with premium options
Sticker calendar + paper log	Older adults, low-tech users	70%	Very High	Free
Voice assistants (e.g., Alexa, Google Home)	People with vision or mobility limits	75%	High	Free (if you own device)

Avoid apps that ask for 10 inputs per dose. Avoid tools that send 5 notifications a day. People tune out. One gentle reminder, tied to a habit they already have, is better than five nagging pings.

What to Do When Progress Stalls

It’s normal to slip. The goal isn’t perfection. It’s progress.

If someone misses three days in a row:

1. Don’t assume they’re noncompliant. Ask: “What changed?”
2. Check for new stressors-job loss, family illness, new side effects.
3. Adjust the goal. Maybe “take pill every day” becomes “take pill 5 days a week, with two catch-up days.”
4. Use small wins. Celebrate 5 days in a row with a text: “You did it! That’s huge.”

A diabetes educator in Ontario shared that when a patient lost her first 2 pounds toward a 20-pound goal, they celebrated with a sticker chart. She went from weighing herself twice a week to five times. Why? Because she felt seen.

What Providers Need to Know

Doctors and nurses aren’t expected to be tech experts. But they do need to know how to start the conversation.

Use this script:

“Taking your meds regularly is one of the most important things you can do for your health. But I know it’s hard. What’s the biggest challenge for you right now?”

Then listen. Don’t jump to solutions. Let them name the barrier. Then build the goal together.

Also, use templates. Many EHRs now have built-in SMART goal fields. Epic, Cerner, and others support standardized data entry. That cuts documentation time by 37%, according to Vozo Health.

What’s Coming in 2026

The future of adherence tracking is smarter-but not more complicated.

By 2026, all major EHRs in Canada and the U.S. will be required to include standardized goal fields under the ONC’s Interoperability Rule. That means:

• Your goal will be saved in your medical record-not just in a notebook.
• Your provider will see your progress without asking.
• AI will flag when you’re at risk of missing doses-before you miss them.

New tools like ingestible sensors (tiny chips that tell your phone when you swallowed your pill) are being tested. Voice assistants are learning to recognize when someone sounds tired or confused and ask, “Did you take your meds today?”

But the real breakthrough? Goals that adapt. If you live in a low-income neighborhood with poor transit, your goal won’t be “go to the pharmacy every Monday.” It’ll be “get your meds delivered every 30 days.” That’s called “adaptable SMART”-and it’s already being piloted by CMS.

Final Thought: It’s Not About Compliance. It’s About Control.

People don’t want to be told what to do. They want to feel in charge of their health. SMART goals aren’t about policing behavior. They’re about giving people the tools to feel confident, capable, and heard.

When someone says, “I took my pill every day this week,” that’s not just data. That’s pride. And that’s what keeps people alive.