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Compliance: How to get patients on board


Under new P4P requirements, your bottom line will suffer if they don't follow your advice.

In fact, many physicians may be unrealistically optimistic about how well patients follow their advice on medication, diet, smoking, or exercise. Numerous studies have found that noncompliance rates for prescribed medication ranges from 15 to 28 percent. According to one oft-cited adage, only a third of all patients take their medication all the time, another third take it some of the time, and one third don't take it at all. And, as former US Surgeon General C. Everett Koop once pointed out, "Drugs don't work in patients who don't take them."

Research on nonadherence reveals several possible contributing factors: poor communication between doctor and patient, lack of confidence in the doctor's ability, doubts about the medication's effectiveness, and concerns about its side effects or cost. Many patients are also unwilling to do things that are unpleasant, annoying, or deprive them of pleasures, such as smoking or drinking.

To help boost patient compliance, here's some advice gathered from both researchers and veteran practicing physicians.

Re-evaluate patient relationships. Over the years, you may have steadily increased the number of patients you see each day. But as you cut the time you spend with each patient, you may also be eroding the trust and respect they have for you. As researcher Tom Wroth, an assistant professor of family medicine at the University of North Carolina puts it, "If the patient trusts the physician, and has confidence in him, and believes that he knows what he's doing, the patient is more likely to follow through with the medication course."

Listen to your patients. Building a trusting bond with your patients means taking the time to listen to their concerns. Your discussions with them should take the form of a dialogue, not a monologue. Especially with those who may be noncompliant, it's important to ask why they're not following your advice, and to listen carefully to their response. If they seem reluctant about taking a medication, ask why. You may discover that they're worried about its side effects, or fear it's too expensive, or too big to swallow.

Trust in you may not be the issue at all. Some patients may have personal circumstances that interfere with compliance-attitudes, beliefs, family problems, or lifestyle habits. For example, if you're trying to convince a patient to cut down on smoking, drinking, or overeating, it's worth finding out if his spouse indulges in the same habits, which makes compliance more difficult. Or if you're trying to persuade a single mother to get more exercise, you should know if the demands of her job, children, and aging parents leave little time or opportunity for it. If the patient has previously tried and failed to break a bad habit, ask what he thinks stopped him.

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health