Best Ways to Deal With Noncompliant Patients

Mark Crane, BA

Disclosures

June 05, 2009

In This Article

Introduction

Once you've figured out what's ailing your patient, the real challenge is convincing him or her to follow your advice. Only half of all chronically ill patients take medicines as directed, and many don't even bother to get the prescription filled, according to a 2003 World Health Organization study.

Beyond that, many patients refuse to make recommended lifestyle changes that can improve their health.

Noncompliance is dangerous for the patient and frustrating for the physician. As more insurers and Centers for Medicare & Medicaid Services (CMS) promote pay-for-performance programs, physicians will potentially be scored and reimbursed on the basis of patient outcomes -- meaning that noncompliant patients could drag down doctors' scores.

Patient refusal to follow a treatment regimen also affects the nation's healthcare system. "The cost of patient noncompliance is easily in the tens of billions of dollars a year in needless complications and hospitalizations," says David B. Nash, MD, MBA, an Internist and Chairman of the Department of Health Policy at Jefferson Medical College in Philadelphia, Pennsylvania. "If we could improve compliance, we'd be well on our way to fixing the healthcare system regardless of what reforms are ultimately passed."

Up to 11% of hospital admissions, 40% of nursing home admissions, and about 125,000 deaths a year are due to noncompliance with prescribed medication regimens, according to the American Pharmacists Association. As former US Surgeon General C. Everett Koop once lamented, "Drugs don't work in patients who don't take them."

Economic Woes Increase Noncompliance

Today's tough economy has created new reasons why more patients are noncompliant. Patients don't take medications if they can't afford them. Many patients who have lost their jobs and health insurance are forgoing prescription drugs or office visits.

"People who have lost jobs are putting off preventive care and canceling routine visits," says Rick Kellerman, Chair of the Department of Family and Community Medicine at Kansas University School of Medicine in Wichita, Kansas, and past president of the American Academy of Family Physicians (AAFP). "That creates long-term potential for conditions to develop into more serious illnesses."

On the basis of widespread money problems, physicians should take the time to ask about a patient's financial circumstances that can affect compliance.

"Patients are often reluctant to tell physicians that they've lost a job and can't afford medicine," says Kellerman. "Perhaps it should be part of a standard history to inquire about whether they might have trouble filling prescriptions or returning for follow-up care."

It's especially important to counsel patients about dosage when money is tight because some patients split pills to make them last longer. Physicians can also provide free samples, substitute generics whenever appropriate, and refer patients to pharmaceutical company or government assistance programs.

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