A more concerted effort, with multifaceted strategies aimed at the patient, clinician, health system, and health plan, is needed to overcome the barriers and achieve wider guideline implementa- tion (Table S7). The patient is a key player in success- ful guideline implementation, and the clinician patient discussion is crucial to the successful initiation and con- tinuation of guideline-directed management and thera- py (Table 7). As part of the clinician patient discussion, the patient should be encouraged to state what was heard, ask questions, express values and preferences, and state ability and willingness to adhere to lifestyle changes and medications. This is where a discussion of out-of-pocket costs can occur. Clinicians should use multiple interventions to promote adherence, including asking more specific questions about adherence, aim- ing for once-daily dosing, using automated reminders, participating in multidisciplinary educational activities, and using pharmacist-led interventions. Recommendation-Specific Supportive Text 1. Interventions focused on improving adherence to prescribed therapy are recommended for man- agement of adults with elevated cholesterol lev- els. A Cochrane systematic review demonstrated that intensification of patient care interventions improves both short- and long-term adherence to medication, as well as meaningful reduction in LDL-C levels. Interventions include telephone reminders, calendar reminders, integrated mul- tidisciplinary educational activities, simplification of the drug regimen to once-daily dosing, and Clinicians may wish to review Table S7 in the Web Supplement, Strategies to Improve Guideline Implementation by Setting and Target Audience Measures to Improve Lipid Medication Adherence. 2. Clinicians do not follow guidelines for many and cholesterol guideline implementation has not been optimal.S6-10 S6-13 Interventions aimed at the clinician may improve guideline implemen- tation. 