NON-COMPLIANCE AND NON-ADHERENT CAUSES AND SOLUTIONS

James R. LaSalle, D.O., FAAFP

Patient adherence to medical advice and prescribed treatments is one of the most important determinants of successful outcomes in today’s health care environment. Despite advances in medical therapies and technology, non-compliance and non-adherence remain persistent barriers to optimal care.

Studies suggest that approximately 50% of patients with chronic diseases fail to take their medications as prescribed, and similar trends are observed in the failure of lifestyle modifications including diet, exercise and required follow up visits. Understanding the causes of these barriers and implementing strategies to improve adherence are crucial to providers, patients and to health care systems as a whole.

• A. Fear and Anxiety

If we ponder why patients fail to comply or adhere to medical advice, it is often a complex and a multi-factorial problem. Fear of the unknown is a powerful emotion and generally causes patients to see only the worst outcomes. These feelings spill over into rationalizations about not taking medications, surgery and other modalities. Fear provokes patients to go into hiding.

Solutions

This then suggests that educational strategies must be instituted at diagnosis. These classes would define the medical problems and potential solutions. “Awareness” is a crucial component to treatment. The second component of these educational strategies is making patients embrace their own “advocacy”. Giving patients reputable websites for their conditions and showing them how to navigate these sites is critical. Now patients can be armed with verifiable information that would allow them to have realistic conversations with their providers to seek “appropriate actions”. Patients should never be afraid to seek second opinions if the data and their provider’s recommendations do not jive. Advocacy is about knowledge.

• B. Financial Barriers

High costs of medications, diagnostic testing and specialist visits often discourage patients from following physician recommendations. Even with insurance, co-pays and deductibles can pose significant burdens. Equally important is an understanding how patients may attempt to solve the economic burdens of their chronic disease. Patients may ration medications, skip doses or abandon treatment altogether due to financial strain. Once again, provider awareness is vital for understanding the potential for inappropriate patient solutions to financial short comings.

• C. Solutions

Physicians may be able to prescribe generic alternatives and connect patients with pharmaceutical assistance programs to mitigate some of the financial burden. Hospitals are skilled in navigating insurance company complexities and may be a valuable resource for appropriate insurance claim filing to decrease out-of-pocket medical expenses. Further, making patients aware of clinical trials dealing with their specific disease conditions might be an additional solution for many patients.

Cultural and Religious Beliefs

Cultural attitudes toward medicine, reliance on traditional remedies or religious objections to certain therapies may conflict with physician recommendations. Advocacy on behalf of patients includes respecting cultural values while guiding them toward safe, evidence-based care. Advocacy includes engaging community leaders and family members to assist in these sensitive issues.

Mental Health and Cognitive Factors

Pre-existing depression, anxiety, dementia and other psychological or cognitive impairments frequently reduce adherence. Awareness of these conditions enables early intervention and targeted support for affected patients. Integrating chronic disease management with mental health professionals early may lead to higher rates of success.

Practical Barriers

Busy schedules, transportation issues, and complex medication regimes make adherence and compliance difficult. Appropriate action, by simplifying treatment strategies, and telemedicine can positively affect logistic obstacles. Certain insurance benefits provide transportation to and from clinic visits.

Summary

Patient non-compliance and non-adherence remain major challenges in modern healthcare, affecting patient’s well-being, costs, and most of all patient outcomes. The reasons are complex ranging from fear related poor communication, financial stresses and cultural issues. However, amalgamating patient awareness of specific barriers, fostering patient education/advocacy and the implementation of practical solutions based on appropriate action, healthcare outcomes will clearly improve.

The four A’s of Awareness, Advocacy and Appropriate Action must become standards of care in chronic disease management.

References

1. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353 (5): 487-497.
2. Brown MT, Bussell J. Medication Adherence: WHO cares? Mayo Clin Proc.2011;86(4):304-314
3. Nieuwlaat R, Wilczynski N, Navarro T, et al.Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2014;2014(11):CD000011.