July 31, 2007

What the Heck is Non-Compliance?

Excellent article on compliance (following your doctor’s directions) and what influences it

Most people follow only half of their doctor’s advice. The half they don’t follow often means the difference between a successful treatment and a lingering illness or even death. Find out what you can do to get the most out of your health care. It is so common for patients to disregard their doctor’s advice that there is a term for it in medical circles: Noncompliance. In fact, numerous studies and countless seminars and educational materials have been dedicated to solving this problem. A noncompliant patient is one who simply forgets to take medications on time, misunderstands the directions, cannot make the lifestyle changes required for certain treatments or simply ignores medical advice. Such neglect often has tragic consequences. It is estimated that 125,000 people with treatable ailments die each year simply because they do not take prescribed medications properly or they skip them altogether.

The blame for noncompliance, however, does not lie entirely with the patient. Health care professionals frequently fail to take the time to clarify a treatment, make sure the patient understands why it’s important to follow the plan precisely, explain possible side effects, or ask if a patient’s lifestyle might interfere with the therapy so that it can be customized.

Ideally, a patient and doctor should work together as a team to ensure the most effective medical care. But it doesn’t always work out that way. So don’t assume your health care provider is giving you all the pertinent information. Whenever treatment is prescribed–even if it’s a simple course of antibiotics–make sure you have all the facts, including the possible results of not following through with your doctor’s recommendations.

Why Patients Don’t Comply

Often, people do not follow their physician’s instructions because they don’t have adequate information regarding their condition or medication. Other reasons for noncompliance:

Symptoms disappear before treatment is finished. Many patients discontinue medications or other forms of therapy as soon as they feel better, even though the healing process is not yet complete. This is particularly true with antibiotics.

The treatment causes more symptoms than the illness. Many medicines cause uncomfortable side effects, so when patients have disorders such as hypertension, which have few or no discernible symptoms, it is hard for them to see the benefit of taking a drug that makes them feel worse. For the same reason, noncompliance is very high when medication is prescribed to prevent an illness from developing.

"It can’t happen to me." Some patients with threatening health problems, such as high blood pressure or high blood cholesterol, refuse to take the necessary precautions because they believe heart attacks only happen to "other people."

Life-style changes are too hard to make. Many patients have a difficult time making prescribed life-style changes, such as quitting smoking, exercising regularly and changing their eating habits.

Patients come to identify the treatment with their illness. Some people hate feeling dependent on drugs, so they stop taking their medication to deny they are sick. Others stop taking medicine to see if they are "cured" yet.

Patients adjust the dosage of their medication without consulting their physician. Many people, particularly those with chronic ailments, feel a need to take control of their problem. And they try to do so by taking control of their medication dosage.

The cost of treatment is too high. Many prescription drugs are extremely expensive.

Work and family demands interfere with following the therapy correctly. Due to hectic schedules, people sometimes find it hard to stick to their treatment regimen.

What You Can Do to Maximize Your Treatment

The most important factor in making the most of your medical care is good communication between you and your doctor. Here are some practical steps you can take to accomplish that goal:

1. Tape record or write down what the physician says.

2. Make sure you understand the prescription schedule, and let the doctor know if you think your activities will interfere with it. Call your physician if you find that you cannot take your medication at the appropriate times. Together, you can work out a schedule that meets your needs. (See Make the Most of Your Medications.)

3. Ask what you should do if you miss a dose of medication or a therapy session and whether you should discontinue treatment when you feel better.

4. Let your doctor know if you have had bad experiences in the past with any portion of the prescribed treatment plan and if you are currently being treated for another condition. Find out how to manage both treatment plans simultaneously.

5. Find out what side effects you should expect and which aren’t normal and should be reported to your doctor.

6. Ask for a referral to a support group that deals with your ailment. If your therapy calls for lifestyle changes you feel will be hard for you to make, ask for a referral to a professional who can help, such as a dietitian for changes in your diet or a smoking program for quitting smoking.

7. Don’t be afraid to ask the doctor to simplify instructions by using less technical terms or giving you concrete examples. If your doctor seems impatient with your questions or brushes them off, explain that it is important to you to understand the recommendations clearly because you want to be able to follow them. If your physician still is not responsive, you may want to consider finding another doctor who appreciates an involved patient.

8. If you cannot afford the prescribed drug, ask your doctor about manufacturer aid. Most major drug companies now have programs to give drugs to patients who either don’t have insurance or the means to pay for their medications. The details of such aid vary widely depending on the manufacturer, but all of them require that the doctor put in the application for you

Filed under General Medical, Articles by Terrie Wurzbacher