Lack of trust: If for whatever reason, you don't believe your treatment is going to make a difference in your health, you may not be motivated to comply. Apathy: When you don't realize the importance of the treatment, or you don't care if the treatment works or not, you are less likely to comply.
Full Answer
Why aren’t your clients complying with treatment recommendations?
Many veterinarians feel that money is the primary reason that clients don’t follow treatment recommendations. However, research tells a different story: only 2-10% of clients say they decline recommendations due to cost. So if it’s not about price, why aren’t your clients complying?
What do we know about patient compliance with treatment?
The topics of interest in the field of patient compliance were: factors that influence therapeutic non-compliance and the extent of non-compliance with treatment. Only non-compliance studies from the patient’s perspective were selected. Original studies that included fewer than 50 patients were eliminated because of inadequate sample size.
What causes lack of compliance with treatment?
Apathy: When you don't realize the importance of the treatment, or you don't care if the treatment works or not, you are less likely to comply.
What happens when a client is not doing certain tasks in therapy?
If a client is not accomplishing certain tasks in therapy, then perhaps these aren’t important to the client and the therapist is simply imposing their own agenda on the client. 3) Therapist inflexibility.
What are the factors identified from studies and reviews?
The factors identified from the studies and reviews may be grouped into several categories, namely, patient-centered factors, therapy-related factors, healthcare system factors, social and economic factors, and disease factors (Table 2).
What age group was included in the Medline study?
Only English-language journal articles with abstracts were included. The populations were adolescents aged 13–18 years and adults aged 19 years or older. Clinical trials were excluded since they were carried out under close monitoring and therefore the compliance rates reported would not be generalizable. Articles which were categorized by Medline in subsets on AIDS, bioethics, history of medicine, space life sciences and toxicology were not included as well.
What are the negative effects of non-compliance?
Besides undesirable impact on clinical outcomes, non-compliance would also cause an increased financial burden for society. For example, therapeutic non-compliance has been associated with excess urgent care visits, hospitalizations and higher treatment costs (Bond and Hussar 1991, Svarstad et al 2001). It has been estimated that 25% of hospital admissions in Australia, and 33%–69% of medication-related hospital admissions in the USA were due to non-compliance with treatment regimens (Sanson-Fisher et al 1992; Osterberg and Blaschke 2005). Additionally, besides direct financial impact, therapeutic non-compliance would have indirect cost implications due to the loss of productivity, without even mentioning the substantial negative effect on patient’s quality of life.
How many articles were reviewed in the literature review?
A total of 102 articles was retrieved and used in the review from the 2095 articles identified by the literature review process. From the literature review, it would appear that the definition of therapeutic compliance is adequately resolved. The preliminary evaluation revealed a number of factors that contributed to therapeutic non-compliance. These factors could be categorized to patient-centered factors, therapy-related factors, social and economic factors, healthcare system factors, and disease factors. For some of these factors, the impact on compliance was not unequivocal, but for other factors, the impact was inconsistent and contradictory.
What is the ultimate goal of a prescribed medical treatment?
The ultimate aim of any prescribed medical therapy is to achieve certain desired outcomes in the patients concerned. These desired outcomes are part and parcel of the objectives in the management of the diseases or conditions. However, despite all the best intention and efforts on the part of the healthcare professionals, those outcomes might not be achievable if the patients are non-compliant. This shortfall may also have serious and detrimental effects from the perspective of disease management. Hence, therapeutic compliance has been a topic of clinical concern since the 1970s due to the widespread nature of non-compliance with therapy. Therapeutic compliance not only includes patient compliance with medication but also with diet, exercise, or life style changes. In order to evaluate the possible impact of therapeutic non-compliance on clinical outcomes, numerous studies using various methods have been conducted in the United States (USA), United Kingdom (UK), Australia, Canada and other countries to evaluate the rate of therapeutic compliance in different diseases and different patient populations. Generally speaking, it was estimated that the compliance rate of long-term medication therapies was between 40% and 50%. The rate of compliance for short-term therapy was much higher at between 70% and 80%, while the compliance with lifestyle changes was the lowest at 20%–30% (DiMatteo 1995). Furthermore, the rates of non-compliance with different types of treatment also differ greatly. Estimates showed that almost 50% of the prescription drugs for the prevention of bronchial asthma were not taken as prescribed (Sabaté 2003). Patients’ compliance with medication therapy for hypertension was reported to vary between 50% and 70% (Sabaté 2003). In one US study, Monane et al found that antihypertensive compliance averaged 49%, and only 23% of the patients had good compliance levels of 80% or higher (Monane et al 1996). Among adolescent outpatients with cancer, the rate of compliance with medication was reported to be 41%, while among teenagers with cancer it was higher at between 41% and 53% (Tebbi et al 1986). For the management of diabetes, the rate of compliance among patients to diet varied from 25% to 65%, and for insulin administration was about 20% (Cerkoney and Hart 1980). More than 20 studies published in the past few years found that compliance with oral medication for type 2 diabetes mellitus ranged from 65% to 85% (Rubin 2005). As previously mentioned, if the patients do not follow or adhere to the treatment plan faithfully, the intended beneficial effects of even the most carefully and scientifically-based treatment plan will not be realized. The above examples illustrate the extent of the problem of therapeutic non-compliance and why it should be a concern to all healthcare providers.
Why is non compliance important?
Non-compliance is directly associated with poor treatment outcomes in patients with diabetes, epilepsy, AIDS (acquired immunodeficiency syndrome), asthma, tuberculosis, hypertension, and organ transplants (Sabaté 2003). In hypertensive patients, poor compliance with therapy is the most important reason for poorly controlled blood pressure, thus increasing the risk of stroke, myocardial infarction, and renal impairment markedly. Data from the third NHANES (the National Health and Nutrition Examination Survey), which provides periodic information on the health of the US population, showed that blood pressure was controlled in only 31% of the hypertension patients between 1999 and 2000 (Hajjar and Kotchen 2003). It is likely that non-compliance with treatment contributed to this lack of blood pressure control among the general population. For therapeutic non-compliance in infectious diseases, the consequences can include not only the direct impact such as treatment failures, but also indirect impact or negative externalities as well via the development of resistant microorganisms (Sanson-Fisher et al 1992). In addition, it has been shown that almost all patients who had poor compliance with drugs eventually dropped out of treatments completely, and therefore did not benefit at all from the treatment effects (Lim and Ngah 1991).
Is non compliance a negative effect?
Hence, from both the perspective of achieving desirable clinical and economic outcomes, the negative effect of therapeutic non-compliance needs to be minimized. However, in order to formulate effective strategies to contain the problem of non-compliance, there is a need to systematically review the factors that contribute to non-compliance. An understanding of the predictive value of these factors on non-compliance would also contribute positively to the overall planning of any disease management program.
Why are patients not compliant?
There are many reasons why patients resist following instructions, but a comprehensive approach can help doctors change behavior . One hurdle in treating patients, particularly children and teens, is ensuring compliance with treatment protocols. It can feel like an uphill battle, ...
What to write in a patient's treatment plan?
Written plan: Don’t rely on patients’ memories. Give them written instructions that include an explanation of their condition, treatment tips, guidance for managing flare-ups, and details on when to call you.
Is patient adherence a focus?
Concentrating on patient adherence might not be your primary focus, Feldman says, but with the right compliance protocol you could be as effective in helping patients stick with treatment as you are providing a diagnosis.
Is treatment worse than disease?
7. Treatment is believed to be worse than disease
Why is mental health so difficult to access?
Quality mental health care isn't always easy to access. Some people with mental illnesses have had bad experiences with rude, unqualified, or high-pressure mental health professionals. This can cause them to worry that medication will undermine their personal autonomy, either because the medication will change their personality or because it will put them under the control of a doctor. In one survey, 7 percent of people reported that they avoided medication because they were worried about being hospitalized against their will. Another 5 percent reported that they were displeased with the quality of services available.
Why do people refuse to take medication?
One study found that 55 percent of people who refuse to take their medication do so because they don't believe they're actually sick. In some cases, people who get better on medication become convinced that they've been “healed,” failing to recognize that the medication did the healing. In others, people simply can't accept that their thinking is abnormal. Mental illnesses carry a significant stigma, so it's understandable that some people do not want to believe they're mentally ill. Reducing mental health stigma and avoiding labeling people with mental illness can help solve this challenge, since 6 percent of people with mental illness report that they avoid medication because they're worried what others would think.
Why do people with mental illness avoid medication?
Reducing mental health stigma and avoiding labeling people with mental illness can help solve this challenge, since 6 percent of people with mental illness report that they avoid medication because they're worried what others would think. article continues after advertisement. Fear and Procrastination.
What happens if a person is bullied by a therapist?
If a person feels bullied or pressured by her psychiatrist or therapist, she may stop treatment altogether.
How to help someone with autonomy?
Friends and family can help alleviate concerns about personal autonomy by avoiding threats. Consider also abandoning the subject of medication and talking about other ways to manage your loved one's illness. Some people avoid psychoactive medications specifically because they feel so much pressure from loved ones to try them. Steering clear of medication in these cases serves as an assertion of personal autonomy.
What are the side effects of mental health?
Side effects of mental illness medications range from mild to severe, but some of the most common include: • Sexual dysfunction. • Weight gain. • Physical symptoms, such as nausea or headaches. • Changes in mood or thoughts. • Skin problems.
Can anxiety make you anxious to see a psychiatrist?
A person with an anxiety disorder may be anxious about making a psychiatrist appointment, even when she knows medication can help. A person struggling with depression may plan to call the psychiatrist every day for a month, only to endlessly procrastinate in a haze of self-loathing and hopelessness.
What is treatment compliance?
Treatment compliance is defined as the degree to which patients’ behaviors (e.g., attending follow-up appointments, engaging in preventive care, following recommended medical regimens) correspond with the professional medical advice prescribed. The terms compliance and adherence are often used interchangeably; however, because compliance may carry a negative connotation, some prefer to use adherence to emphasize patients’ active roles in healthcare management as opposed to the submissiveness suggested in the definition of compliance. This distinction in definition acknowledges that patients and providers can move away from the patriarchal model of health care, promotes patient autonomy, and takes into account evidence suggesting that those who adhere steadfastly to providers’ instructions may not be the healthiest psychologically or physically. While the patient’s active role is considered vital in committing to a treatment regimen, for the purposes of this overview, the term compliance is utilized to maintain consistency.
How does treatment compliance affect adolescents?
For children and adolescents, treatment compliance is influenced by numerous factors. In general, females are more compliant than males, and adolescents are less compliant than younger children. Among adolescents, researchers report that compliance may be related to adolescents’ needs for independence combined with their willingness (or lack thereof) to accept the authority of healthcare providers. For example, research suggests that a cancer diagnosis coupled with cognitive impairments resulting from aggressive treatments predicts poorer decision-making abilities, including higher incidences of high-risk behaviors (e.g., smoking, drug use). Self-esteem, cognitive and social functioning, lower socioeconomic status, lower parent education, feelings of invincibility, illness knowledge, perceived vulnerability, treatment complexity, emotional problems, and prevailing psychiatric illness also relate to compliance.
What are some examples of predictors of compliance?
Examples of predictors of compliance are readily available. Online surveys find that most cancer patients and providers believe good communication promotes compliance; unfortunately, relatively few providers are comfortable discussing alternative or complementary therapies. Additionally, research among HIV/AIDS (acquired immune deficiency syndrome) patients suggests that poor social support, underestimation of illness severity, lack of factual information (e.g., not knowing the difference between HIV and AIDS), healthcare system distrust, side effects, and beliefs that medications are ineffective all decrease compliance.
How does home health care improve compliance?
Home health care increases compliance by increasing satisfaction with staff and decreasing treatment administration wait times. As com-pared to home health care, similar improvements in compliance are identified through educational interventions aimed at enhancing disease and treatment knowledge and through behavioral interventions, which assist with pain management and pill-taking procedures. Healthcare providers often also emphasize relaxation therapy and systematic desensitization to control side effects and promote compliance, although these approaches are less empirically supported.
Why is compliance with asthma so problematic?
For example, among children with asthma, compliance is often problematic, because the disease can be unpredictable with long symptom-free periods.
How does compliance increase?
Compliance increases when patients believe treatments are necessary and important. Healthcare providers play a critical role in this process by helping patients weigh the risks and benefits while taking into consideration social contexts and perceived barriers. Successful compliance also requires that an individual develops the motivation and self-efficacy required to confront a long-term stressor.
Why are self-reports used?
Self-reports are commonly used to assess compliance . Examples include Likert scale questionnaires, handheld computers, and phone diaries. Although self-report measures are the simplest measures to use, report bias and recall precision issues often make results inaccurate. These inaccuracies can result in over-reporting, because patients may answer questionnaires consistently with what they believe promotes support and approval from providers. Underreporting is also concerning, with some research suggesting higher compliance when using objective measures as compared to self-reports. Despite challenges involved and acknowledgment that self-reports should be interpreted cautiously, because of their practicality, research supports using self-reports in clinical settings.
What is the difference between compliance and adherent?
An article in Podiatry Today does an effective job of comparing the two concepts when it states the following: "Adherence is an active choice of patients to follow through with the prescribed treatment while taking responsibility for their own well-being. Compliance is a passive behavior in which a patient is following a list of instructions from the doctor."
What is medication compliance?
Rita Alloway, in a presentation, notes that medication adherence is the "extent to which patients take medications as prescribed by healthcare providers," while medication compliance is the "passive act of the patient to follow the provider's orders."
Why do patients struggle with treatment compliance?
There are also many reasons patients may struggle with treatment compliance, which often tie back in some way to patient understanding and expectations. For example, if patients are unhappy with a treatment's effects — whether due to limited signs of improvement, slower improvement than desired, or unexpected side effects — they may try to alter how they approach treatment.
What stakeholders are involved in adherence and compliance?
This can include patients and their family members, primary care physicians, specialists, nurses, pharmacists, therapists, billers, collections specialists, and even payors. Improving collaboration and coordination between these stakeholders will have a far-reaching and positive impact on treatment adherence and compliance.
What resources should providers and organizations share?
These can include brochures and pamphlets, mobile apps, and videos.
What is compliance in medical terms?
Compliance is a passive behavior in which a patient is following a list of instructions from the doctor.". The article continues, noting, "Adherence is a more positive, proactive behavior, which results in a lifestyle change by the patient, who must follow a daily regimen, such as wearing a prescribed brace.
How to treat all patients?
Approach each patient with a clean slate. Allocate time to understand what obstacles may hinder an individual's success and then cater your efforts to help the patient by addressing those specific obstacles. Taking a blanket approach to delivering assistance is likely to result in missed opportunities to address particular challenges effectively.
How to deal with anxiety in a therapist?
To address therapist anxieties, a therapist needs a good support system, including people with whom they can discuss their fears. It is also good for a therapist to reframe their fears with anxiety-reducing strategies, such as: 1 Challenging unrealistic performance expectations placed on the self 2 Reminding oneself that it’s okay to make mistakes 3 Focusing on the client rather than on the self 4 Realizing that no mistake is fatal and that part of good therapy involves the concept of “rupture and repair.” When ruptures in the therapeutic relationship occur, repairing of the relationship can be healing in and of itself.
How to deal with client resistance?
The best approach to coping with client resistance or noncompliance is for the therapist to look in the mirror. If all efforts at treatment have apparently failed, then the therapist can step back, regroup, and assess the problem (s) in the treatment protocol. In fact, if the therapist finds themself frustrated with the client’s effort, they may be best-served to “let go” of expectations, as this is a sign that the therapist’s personal agenda is not being met.
Why do therapists need to be willing to engage with their clients?
When a therapist tries to keep the relationship with their clients at a distance because of fears, such as fear of countertransference issues, the clients may sense this distancing. The effectiveness of therapy might then be diminished. A therapist can benefit from taking emotional risks with their clients. Client relationships aren’t so fragile that mistakes can’t be dealt with and overcome.
What happens if a therapist is not client centered?
If a therapist lacks a client-centered approach, then the client will notice (if not consciously, then unconsciously) that their therapist is inflexible or rigid. If a client has issues from childhood resulting from a controlling parent or has problems with authority figures, then they may unconsciously resist what is being perceived as external control from the therapist.
What does a therapist assume about client resistance?
Oftentimes a therapist will assume that client resistance is 100% based on something within the client. In reality, the therapist’s inability to build a strong therapeutic relationship with the client may be a contributing factor.
What are the issues that contribute to client resistance?
Issues contributing to client resistance may include fears of failure or the fear of terminating therapy. One question a therapist can use to address these types of fears is, “What would happen if you were successful?” or something else along those lines. Always explore topics of resistance with curiosity and encouragement.
Why is it important for therapists to understand when they are placing unrealistic expectations on clients based on the therapist?
Remember, clients have their own personal experiences that may or may not be conducive to certain treatment outcomes.
How do counselors contribute to client resistance?
Counselors, both consciously and unconsciously, contribute to client resistance. Counselors may have failed to establish rapport with their client. They may have misguided expectations of client behavior and client roles. The counselor may expect the client to respond in a particular way, and when they do not respond accordingly they assume the client is being resistant. The interventions and techniques used by counselors also may contribute to in-session resistance. Counselors need to be cognizant of the interventions they use, ensuring that they are appropriate for their client in the given moment. Similarly, counselors should only assign homework assignments that are relevant to the issue at hand and that are not too time consuming for the client.
What is a vistas online?
VISTAS Online is an innovative publication produced for the American Counseling Association by Dr. Garry R. Walz and Dr. Jeanne C. Bleuer of Counseling Outfitters, LLC. Its purpose is to provide a means of capturing the ideas, information and experiences generated by the annual ACA Conference and selected ACA Division Conferences. Papers on a program or practice that has been validated through research or experience may also be submitted. This digital collection of peer-reviewed articles is authored by counselors, for counselors. VISTAS Online contains the full text of over 500 proprietary counseling articles published from 2004 to present.
What are the causes of client resistance?
Counselors, both consciously and unconsciously, contribute to client resistance. Counselors may have failed to establish rapport with their client. They may have misguided expectations of client behavior and client
What role does a counselor play in a client's resistance?
roles. The counselor may expect the client to respond in a particular way, and when they do not respond accordingly they assume the client is being resistant. The interventions and techniques used by counselors also may contribute to in-session resistance. Counselors need to be cognizant of the interventions they use, ensuring that they are appropriate for their client in the given moment. Similarly, counselors should only assign homework assignments that are relevant to the issue at hand and that are not too time consuming for the client.
Why are clients resistant to change?
Counselors try to move their clients towards an acceptance of responsibility while clients may be more inclined to strive for evasion of responsibility (King, 1992). Clients simply may not be ready to move where their counselor is taking them. Some clients may be resistant because there is a purpose for their symptoms. The benefits of maintaining their dysfunctional beliefs or behaviors far outweigh the benefits of overcoming them. These clients may enjoy the support and attention they receive by having a mental health condition and may be hesitant to lose the associated benefits. In some cases clients may be resistant to change because change in and of itself is a frightening prospect. As human beings we are creatures of habit, and asking someone to change may lead to the development of resistant behaviors as a productive measure.
What are the resistances in counseling?
This category of resistance consists of behavior patterns clients engage in that violate the basics rules underlying the practice of counseling. The most common forms include poor appointment keeping, payment delay/refusal, and personal favor asking. The object is to avoid engaging the counselor in the counseling process by creating a distraction. These forms of resistance signify that the client may have a negative attitude towards the counselor or towards the counseling process. By ignoring, and in some cases outright defying, established counseling guidelines clients are creating a way for themselves to not participate in the therapeutic relationship.
What is response quantity resistance?
Response quantity resistance is viewed as the client’s noncompliance with the change process. This category consists of a class of behaviors whereby the client limits the amount of information communicated to the counselor. Silence and minimal talk are typical forms of resistance in this category. Otani (1989) identified such behaviors as frequent pauses, taciturnity, silence, and minimal talk as signs that the client may be engaging in this type of resistant behavior. By limiting the amount of information they give to the counselor, clients are able to control the counseling session and prevent the discussion of difficult or emotionally painful topics. This behavior is observed most frequently among involuntary clients, such as court-referred clients (Dyer & Vriend, 1988).
