The Noncompliance Epidemic

Can We Get Patients to Be More Compliant?

Neil Chesanow

Disclosures

January 16, 2014

In This Article

How Far Have We Come in Improving Compliance?

Noncompliance has been studied for decades, but attempts to address the crisis in a systemic, scalable fashion are actually far more nascent than the voluminous research on the subject would suggest.

Kristi Rudkin, Walgreens' Senior Director of Product Development - Adherence, was hired about 4 years ago to fill what was then a new position. The retail pharmacy industry as a whole began to focus on medication compliance at roughly the same time.

In 2006, Geisinger, now a crown jewel in the nation's healthcare system, suffered from "fragmented care, disaggregated care, care that usually led to very imperfect or almost nonexistent information, very high hospital admission rates, a system that was really optimized for managing acute problems rather than patients with chronic disease over time and space, and a lifestyle situation in primary care that was really unsustainable," recalls Geisinger's Thomas Graf.

Initiatives to improve compliance have only just begun, and although some integrated systems have made impressive strides, overall progress has been modest at best -- far too modest, given the dimensions of the crisis, to conclude that we're truly coming to grips with the problem.

"At the heart of this problem lie essential questions about human motivation and physicianhood," wrote cardiologist Lisa Rosenbaum, MD, and internist William H. Shrank, MD, in the New England Journal of Medicine last summer.[57] "Whether patients take their medications is ultimately up to them, but physicians' professional responsibility entails both a willingness to help people in need and a constant effort to do better."

"When it comes to medication adherence," they conclude, "what we're doing now isn't cutting it."

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