Research published in 2011 showed that some of the main reasons why patients do not adhere to treatment plans include:
- The Denial Problem: Many diseases and conditions are easily overlooked, even after they have been diagnosed. This is...
- Treatment costs: Your drugs and treatments may or may not be covered by insurance, and the more out-of-pocket costs you...
What happens when patients are non-compliant?
· Overall, if patients aren’t implementing your guidance, he says, it’s likely for one of these reasons: 1. Lack motivation or the condition isn’t bothersome 2. Seeking some other gain 3. Distrustful of you 4. Scared of the medicine or treatment 5. Forgot your instructions 6. Treatment is more ...
What are the factors that contribute to poor compliance to therapy?
· Epilepsy is a chronic disorder with intermittent symptoms, the treatment of which is often associated with adverse effects. Therefore, problems with compliance are expected and frequently occur. Many patients whose seizures are well controlled will experiment with reducing or discontinuing their medication.
Why don’t patients attend the clinic?
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 ).
When is compliance with medical treatment good or bad?
Patients were identified as non-compliant, using the Morisky-Green test, at two primary health care centres of the Spanish National Health Service. Results: A complex web of factors was identified that influenced non-compliance. Patients had fears and negative images of antihypertensive drugs.
Why do patients not adhere to treatments?
There are many causes of non˗adherence but they fall into two overlapping categories: intentional and unintentional. Unintentional non˗adherence occurs when the patient wants to follow the agreed treatment but is prevented from doing so by barriers that are beyond their control.
What are some reasons why a patient may become non compliant?
Common Causes of Noncompliant BehaviorFailure of Communication and Lack of Comprehension. ... Cultural Issues. ... “Psychological” Issues. ... Secondary Gain. ... Psychosocial Stress. ... Drug and Alcohol Dependence.
What are five reasons why patients do not follow medical advice?
Depending on the patient, provider, and situation, contributing factors may include the patient's social and economic status or education level, the complexity of the treatment and instructions, health system variables, poor provider communication, patient depression or stress, and physical or financial obstacles to ...
Which factors contributes to patient non-compliance?
Factors found to be significantly associated with non-compliance on bi-variate analysis were: female gender (OR = 1.90, CI =1.32-4.57),level of education (Illiteracy) (OR = 5.27, CI = 4.63 - 7.19), urban population (OR =5.22, CI= 3.65 - 8.22), irregularity of the follow-up (OR = 8.41, CI = 4.90 - 11.92), non-adherence ...
What are barriers to compliance?
Table 2Barrier to adherenceNumber of times citedReason for non-adherenceLack of caregiver6,10,11,16,17,19,24,278Social and economic dimensionSecrecy/stigma5,6,8,9,11,24,26,288Access to health care and resources4,5,7,10,17,20,24,26,27,2910Cultural beliefs4,5,7,10,13,17615 more rows•Jan 17, 2018
What are the examples of patient noncompliance?
Common manifestations of patient noncompliance include:Failure to keep follow-up appointments.Failure to complete recommended diagnostic testing or laboratory studies.Failure to comply with consultation recommendations.Failure to follow medication instructions and monitoring regimens.More items...
When a patient does not follow the doctor's orders?
Your doctor's diagnosis and treatment plan are useless if you don't follow his or her advice. Patients who do not follow their doctors' orders, especially patients with chronic conditions, may experience health complications, rapid disease progression, decreased quality of life and even premature death.
What is non-compliance in healthcare?
Noncompliance: Failure or refusal to comply. In medicine, the term noncompliance is commonly used in regard to a patient who does not take a prescribed medication or follow a prescribed course of treatment. A person who demonstrates noncompliance is said to be noncompliant.
How will you address the non-compliance of your patient?
Discuss and document the patient's understanding of the consequences of continued noncompliance. If you are not able to discuss the consequences with the patient in person, explain them in a letter. Describe the actions the patient needs to take, such as calling the office or obtaining a diagnostic study.
What is treatment noncompliance?
Non-compliance with treatment refers to the non-use or discontinuity of the treatment process and inattention or failure to follow the prescribed treatment by the patient.
How do you get a patient to comply?
Strategies for improving compliance include giving clear, concise, and logical instructions in familiar language, adapting drug regimens to daily routines, eliciting patient participation through self-monitoring, and providing educational materials that promote overall good health in connection with medical treatment.
What are the challenges of patient adherence?
Knowing the patient as a person allows the health professional to understand elements that are crucial to the patient's adherence: beliefs, attitudes, subjective norms, cultural context, social supports, and emotional health challenges, particularly depression.
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 treatment worse than disease?
7. Treatment is believed to be worse than disease
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.
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.
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).
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).
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.
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 Do Patients Not Meet the Pharmacological Treatment?
Jose Luis Turabian * Department of Family and Community Medicine, Health Center Santa Maria de Benquerencia, Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain
Abstract
Although there has been a shift from “compliance” (doctor-centered) to “adherence” and successively to “therapeutic alliance” (centered on the patient and the doctor-patient relationship), the basic concept remains complex and has multiple models of boarding.
Keywords
Physician-patient communication; Adherence; Pharmaceutical treatment; Therapeutic adherence; Therapeutic alliance; Medical patient relation
Introduction
Therapeutic compliance has been defined as the degree to which the behaviour of a person corresponds with the recommendations of the health professional [ 1 ]. Several terms associated with the concept of adherence to treatment are used: therapeutic alliance, cooperation, compliance, mutuality, collaboration; among others.
How many people fail to adhere to treatment recommendations?
Research during the past several decades indicates that, depending upon their conditions and the complexity of the regimens required, as many as 40% of patients fail to adhere to treatment recommendations (DiMatteo and DiNicola 1982; DiMatteo 1994, 2004a, 2004c; Lin et al 1995; Rizzo and Simons 1997; Dunbar-Jacob et al 2000; Laederach-Hofmann and Bunzel 2000; Haddad et al 2004; Haynes et al 2004). When preventive or treatment regimens are very complex and/or require lifestyle changes and the modification of existing habits, nonadherence can be as high as 70% (Dishman 1982, 1994; Brownell and Cohen 1995; Katz et al 1998; Chesney 2000; Li et al 2000). Although patients with HIV/AIDS may be highly motivated to adhere, their medication regimens are particularly complex, often involving multiple drug “cocktails” (Catz et al 2000; Heckman et al 2004).
Why does nonadherence go unrecognized in the primary care medical interaction?
Why does such a serious risk factor for nonadherence (and other poor healthcare outcomes) so often go unrecognized in the primary care medical interaction? Research suggests that both patients and their physicians contribute jointly to this problem in the medical interaction. Patient factors that prevent recognition of depression in primary care include lack of awareness and understanding of depression symptoms, complaints of physical symptoms that take precedence or confuse the clinical picture, and failure to admit to psychological symptoms because they fear a stigma of mental illness (Docherty 1997). Patients may be reluctant to talk about non-medical matters because they expect physician disinterest or the risk of embarrassment, or because of anxiety about the possible significance of their psychological symptoms (Roter and Hall 1992).
What are the consequences of nonadherence?
The health consequences of nonadherence can be quite severe. Nonadherence compromises patient outcomes in many different ways but is most obvious when patients fail to take medications that likely would cure or at least effectively manage their illnesses (Miller 1997; Chesney et al 2000; Weir et al 2000). For HIV patients who are not at least 90%–95% adherent, viral replication and consequent disease progression may result (Catz et al 2000; Hinkin et al 2002). For patients suffering from or those at risk of coronary heart disease, nonadherence to medication treatments can jeopardize survival (McDermott 1997). Among diabetic patients, adherence to medication for controlling hypertension is essential to preventing mortality from diabetes and myocardial infarction (Elliott et al 2000). Further, aside from direct biomedical benefits, studies show that health may depend partly upon the act of adhering to a regimen. Some research suggests that adherence, even to a placebo, is itselfbeneficial to health outcomes (McDermott 1997; Irvine et al 1999).
How does adherence to a treatment regimen affect quality of care?
Quality healthcare outcomes depend upon patients' adherence to recommended treatment regimens. Patient nonadherence can be a pervasive threat to health and wellbeing and carry an appreciable economic burden as well. In some disease conditions, more than 40% of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice. While no single intervention strategy can improve the adherence of all patients, decades of research studies agree that successful attempts to improve patient adherence depend upon a set of key factors. These include realistic assessment of patients' knowledge and understanding of the regimen, clear and effective communication between health professionals and their patients, and the nurturance of trust in the therapeutic relationship. Patients must be given the opportunity to tell the story of their unique illness experiences. Knowing the patient as a person allows the health professional to understand elements that are crucial to the patient's adherence: beliefs, attitudes, subjective norms, cultural context, social supports, and emotional health challenges, particularly depression. Physician–patient partnerships are essential when choosing amongst various therapeutic options to maximize adherence. Mutual collaboration fosters greater patient satisfaction, reduces the risks of nonadherence, and improves patients' healthcare outcomes.
What are the predictors of nonadherence to medical treatment?
In meta-analytic work, findings suggest that one of the strongest predictors of patient nonadherence to medical treatment is patient depression (DiMatteo et al 2000). The risk of patient nonadherence is 27% higher if a medical patient is depressed than if he or she is not (it is 30% higher if that patient has end-stage renal disease). Depression has long been known to predict poor health outcomes, a fact that may be explained partly by the adherence problems caused by depression. Depressed patients experience pessimism, cognitive impairments, and withdrawal from social support, all of which can diminish both the willingness and ability to follow treatment regimens.
What is the corpus of literature on patient adherence?
The corpus of literature on patient adherence is large, and there are many conceptual models that attempt to integrate a large number of complex factors that affect adherence (Bowen et al 2001). To manage the size and complexity of the empirical findings of this massive research enterprise, reliance on meta-analytic work is necessary to provide the building blocks for data-driven models of patient adherence. Currently, ongoing meta-analytic studies at the University of California, Riverside, USA, are beginning to identify a number of stable and consistent factors that affect patient adherence (DiMatteo 2004a, 2004c; DiMatteo et al 2000, 2002). Syntheses of the literature, along with new empirical advances, highlight the complexities inherent in understanding and effecting changes in patient adherence and suggest solutions to common problems in medication management. Much that has been learned from recent research on the communication between healthcare providers and their patients can lessen the economic burden of nonadherence and improve healthcare processes and outcomes for patients.
How many adherence citations are there in PubMed?
The research literature on patient adherence is extensive. Over the past 50 years, there have been 32 550 adherence related citations in PubMed and 10 087 in PsychLit. Of these citations, more than 2000 represent empirical research articles that involved the assessment of medical patients' adherence to a variety of physician-prescribed regimens (medication, diet, exercise, lifestyle changes, etc).
What is therapeutic disagreement?
Therapeutic disagreement is a divergence in the views of patients and doctors on the subject of treatment
What is the extent to which an individual changes their health behaviour to coincide with medical advice?
Adherence (compliance) is the extent to which an individual changes their health behaviour to coincide with medical advice
What are the barriers to healthcare?
Barriers to healthcare are a reversible cause of poor medication and appointment adherence. Common factors that reliably influence adherence include patient expectation and knowledge (perception of benefits and hazards of therapy), involvement in medical decisions, availability of social support, and complexity and duration of the prescribed regime.
What is the importance of communication between a patient and a health professional?
The importance of good communication between patient and health professional is increasingly acknowledged in relation to adherence (#N#Reference Stevenson, Cox and Britten#N#Stevenson et al, 2004 ). At its essence this means forging a joint therapeutic agreement with full patient involvement. This is a two-way process in which willingness to discuss mental health issues with a doctor is predicted largely by the perceived helpfulness of and trust in that doctor (#N#Reference Wrigley, Jackson and Judd#N#Wrigley et al, 2005 ). This can be quantified using a tool that measures therapeutic alliance perceived by patient or clinician.
What is intentional non-adherence?
In fact, in long-term studies understandable reasons for discontinuation are more common than irrational reasons. Intentional non-adherence is predicted by the balance of an individual's reasons for and against taking medication, as suggested by utility theory. Intentional non-adherence is a common reason not to start a course of medication , but it may be less common than accidental non-adherence in relation to missing individual doses (#N#Reference Lowry, Dudley and Oddone#N#Lowry et al, 2005 ). Predictors of intentional non-adherence include less severe disease (and feeling well), the desire to manage independently of the medical profession (self-efficacy), disagreement with or low trust in clinicians, and receipt of low levels of medical information (#N#Reference Piette, Heisler and Krein#N#Piette et al, 2005 ).
How often do patients discontinue psychotropics?
Over the course of a year, about three-quarters of patients prescribed psychotropic medication will discontinue, often coming to the decision themselves and without informing a health professional. Costs associated with unplanned discontinuation may be substantial if left uncorrected. Partial non-adherence (much more common than full discontinuation) can also be detrimental, although some patients rationally adjust their medication regimen without ill-effect. This article reviews the literature on non-adherence, whether intentional or not, and discusses patients' reasons for failure to concord with medical advice, and predictors of and solutions to the problem of non-adherence.
What is the degree to which an individual follows medical advice?
The degree to which an individual follows medical advice is a major concern in every medical specialty (#N#Reference Osterberg and Blaschke#N#Osterberg & Blaschke, 2005 ). Much attention has focused on methods to persuade patients to adhere to recommendations, without sufficient acknowledgement that avoidance of sometimes complex, costly and unpleasant regimens may be entirely rational (#N#Reference Mitchell#N#Mitchell, 2007 a ). Equally overlooked is the influence of communication between patients and healthcare professionals. Put simply, if no clear agreement is formed with the patient at the onset of treatment then it should be of no surprise if concordance turns out to be less than ideal. In one study the chance of premature discontinuation was found to be less than half in patients who recalled being told to take the medication for at least 6 months compared with those not given this information (#N#Reference Bull, Hunkeler and Lee#N#Bull et al, 2002 b ). This task is made more difficult when patients lack insight into their condition (see below).
