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Everything doctors need to know about patient non-compliance

  Why does it matter

Green tick -small   5 tips to improve compliance

Have you, as a doctor, ever felt that your patients are not complying with the treatment plan you prescribed? If yes, then you will very well know that patient non-adherence is not only a cause of frustration to the doctors but is also a pressing financial concern.

As per the World Health Organization (WHO) about 50% of prescriptions filled for chronic diseases are not taken correctly, and as many as 40% of patients do not adhere to their treatment regimens. Patient non-compliance is so prevalent that according to research, one-third of the kidney transplant patients do not take their anti-rejection medications, and 40% of heart attack patients don’t take their blood pressure medications. What could be the reasons behind patients refraining from complying with the recommended medicines?

Reasons for lack of medical adherence:

Difficulty of the regimen: Patients may have trouble following certain medical regimens which discourage them from following the entire course of the treatment. The treatment might involve strict restrictions on food habits, sleep cycles and many other lifestyle changes, which not everyone might be comfortable following. In some cases, the prick of a needle or the pain of physical therapy might be the deterrents. Classic example is the lack of regular monitoring of blood sugar among diabetes patients.

Adverse events or side-effects: Almost all medicines have few side effects. Those vary from being minor such as fatigue or loss of taste, to more severe such as stomach ulcers. It is important that patients are made aware of these side effects, so they do not end up stopping the medicine or altering the dosage on their own, because of some ‘unexpected’ side-effects. It is also important to comfort the patients that the medicines have been prescribed keeping in mind the pros and cons.

Lack of concern: Many patients show apathy towards their health and do not care whether the treatment is working or not. Making these patients comply with the treatment plan is more challenging. Besides explaining the benefits of following the treatment plan, sometimes it helps to take the caregiver into confidence regarding treatment compliance.

Cost of the treatment: This can be a major reason for some patients becoming non-adherent. In India, majority (~70%) of treatment cost is borne out-of-pocket by the patients. Since most of the OPD expenses are not covered by insurance companies, patients tend to fall-off the medical treatment course for expensive drugs or other treatment options such as physiotherapy. If you feel this might be a reason for your patient, discuss potential alternative therapies, generic drug options, or even counsel them about the benefits of sticking with the regimen in the near future to bring down the overall health expenditure.

Apart from these, there could be several others reason that lead to patient no-shows or non-compliance. Some of those include busy schedule, forgetfulness, driving distance, or the weather on the day of the medical exam, lack of trust with the hospital, etc.

Impact of patient no-shows on doctors & healthcare systems

The main impacts of patient no-shows on doctors primarily are sub-optimal health outcomes, lost revenue and low job satisfaction. Based on a study conducted to understand how general practitioners respond to patients who are non-compliant, it was found that doctors often feel helpless, frustrated and professionally dissatisfied (*Cite source). For clinics and hospitals, patient no-shows affect their recurring revenue big time, especially when it concerns patients with chronic diseases. Let’s take a few specific cases to understand this:

Importance of compliance in Diabetes:

People diagnosed with diabetes must follow a disciplined, daily medication routine. There are a myriad of reasons why people with diabetes would deter from taking their medications. It could be the discomfort after taking the drugs, side-effects of the drugs like weakness, nausea, vomiting and the like. Diabetologists have a hard time inspiring patients to stick to the medication course. Various studies done to understand this kind of patient behavior led to the conclusion that multifaceted professional interventions can enhance the performance of health professionals in managing diabetic patients.

Importance of compliance in Heart conditions:

Non‐compliance with the recommended medication and other lifestyle changes is a major problem in patients with heart diseases. Studies have often established a strong relationship between patient non-compliance and fluid restriction, clinical instability, heart failure exacerbation, and all of these eventually leading to hospitalization. Based on studies, the various ways in which cardiologists can help improve compliance include education and counselling on heart health, timely follow-ups (home visit + phone), mailing educational materials, teaching self-management and the like.

Importance of compliance in Asthma:

Effective asthma treatment demands periodic tracking of the symptoms and measuring how well your lungs are working. Taking an active role in managing your asthma treatment is mandatory to maintain better long-term asthma control, prevent asthma attacks and avoid long-term problems. Long-term control medications are required to reduce asthma flare-ups. Patient education and teaching self-management to asthma patients are found to be integral in managing this condition in the long-term.

Although these are some examples, these can definitely be extrapolated to doctors from other specialties. Patient-oriented interventions, through education and awareness initiatives have been observed to improve adherence across the board.

How to deal with patient non-compliance

Understanding the reasons for each patient towards being non-compliant is always a good start. In addition, the following points would help:

    1. Have a frank discussion with the patient about how important it is to complete a certain medication and/or make certain lifestyle changes. Convince him/her that you are not being judgmental at all and explain the grave consequences of not following through the treatment.
    2. Make the patient feel that he/she is given a very personalized treatment plan and not a generic one. This helps build the trust factor.
    3. Frankly ask the patient if affordability is a factor. If yes, then propose less expensive yet effective alternatives.
    4. Make sure to document the consent discussions of the patient and his/ her behavior in terms of adherence.
    5. Most importantly, take help of a ‘tickler’ system that nudges the patient at every step of the treatment journey, including reminders about follow-up visits, alerts in case of missed or cancelled appointments, non-receipt of test results, or failure to comply to prescription. Sometimes, it is useful for you and your staff to receive these alerts so that human action can be taken after a certain threshold.

Remember, technology only goes thus far. Eventually, human touchpoints make significant difference in terms of quality and outcomes of healthcare delivery. Having an automated system in place that gives you timely alerts will go a long way in helping you reduce the quantum of non-compliance. Not only will this save you significant money that is lost in the form of lost revenue due to patient non-adherence, it will also help you convert your compliant patients into your true brand ambassadors. It is time to do away with the conventional ways and utilize a more advanced system, like the OPD management platform by OPDlift.

OPDlift provides a very easy-to-use, fully automated service to improve patient engagement by sending timely reminders to patients about their appointments and automatically schedules their follow-ups. The platform is built to improve the experience and satisfaction for both patients and doctors, without requiring any app install for patients. We can assure you a smoother practice with OPDlift, and a more compliant patient base.

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