The Noncompliance Epidemic

Why Are So Many Patients Noncompliant?

Neil Chesanow

Disclosures

January 16, 2014

In This Article

Conflicting Perspectives on Compliance

When you prescribe drugs for patients with chronic conditions, or advise them to go on a diet, it's natural to assume that because patients come to you as their medical expert, you share the same goal: the patients' long-term health.

But this may not be the case. In fact, doctors and patients tend to have conflicting perspectives on the burden of adhering to the medication and lifestyle regimens that the doctors prescribe. Doctors "want to maximize patients' health outcomes in the future and are less interested in patients' anticipatory feelings in the present," one paper points out.[30] Patients "put more weight on leading an easier life now rather than thinking of the consequences of their future health status."

It might be easier to bridge this gap if the doctor-patient relationship still had the influence it once did, but with many patients switching health plans, and often doctors, on a yearly basis as premiums are raised, the relationship now is often perfunctory. The more patients you are forced to see to pay the bills, the less time you have to explore and address patient barriers to compliance.

Too-brief visits with the doctor and leaving with more questions than answers may be a reason why many patients seek medical advice elsewhere. The prospect of patients visiting healthcare Websites on the Internet (the quality of whose information can be highly variable), rather than trusting you to know what you're doing, may make smoke come out of your ears. But now patients are visiting social networking sites, specifically for patients with chronic diseases, where they compare notes.[32] They discuss their medications, dosages, and adverse events with each other, give each other advice, and often take that advice.

One study found that 55% of patients rely entirely on their physician to make treatment decisions.[33] That means 45% are seeking advice elsewhere. In another study, 68% of patients turned to other sources to validate information received from their doctors.[34] These other sources, needless to say, aren't other physicians.

Even when doctors take the time to explain things to patients, many patients have little or no idea of what the doctors are talking about. Nearly half of all adults in the United States -- 90 million people -- have trouble understanding what the doctor tells them about why they are sick and how to adhere to medication regimens, according to the Institute of Medicine.[35]

"Each patient, in reality, has his or her own unique barriers, which can vary by disease and medication," a team of RAND researchers concluded.[15] "Programs for improving adherence must find a balance between 'customized' interventions and effective programs that work for large groups or classes of patients.

"This is not to say that society needs thousands of different programs for each barrier," the researchers continued, "but it needs programs that can identify these barriers and take the diversity of individuals and barriers into account."[15]

We are not there yet.

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